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					                                                                  POSTER PRESENTATION
                                                                   26 April 2002, Friday

PP-344                                                                           patients with moderate severity of asthma (female -13, mean age
                                                                                 43.1±1.90 years) asthmatic symptom score, peak expiratory flow rate
INFLUENCE OF EDUCATIONAL PROGRAM ON THE                                          (PEFR) and FEV1 were examined. For assessing of quality of life we used a
QUALITY OF LIFE IN ASTHMA PATIENTS                                               short and simple AQ20 questionnaire (P. Jones e.a.). Before the treatment
                                                                                 the average FEV1 was 68.1±4.7% (M±m) pred, PEFR was 321.5±19.3
A. Kalieva1, N. Brimkulov2                                                       l/min. FP treatment led to a significant reduction in asthma score,
 National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan        improvement of bronchial patency and increasing of quality of life (table).
  Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan                              Thus, fluticasone propionate in 800 µg daily dose was finding in patients
                                                                                 with moderate asthma as the effective antiasthmatic drug, which improve
The aim of this work was to evaluate the influence of the educational            clinical state, ventilatory parameters and quality of life in asthma patients.
program on the Quality of Life of asthma patients. Sixty patients (38
women and 22 men, aged 35.9±4.38) were investigated before education
and after one year period. The patients were divided into two groups: the        Table. Mean change in asthma patients variables before and during
first group went through the educational course and was observed by              treatment
pulmonologists; the second group was under observation by general
practice. For assessing of quality of life E. Juniper’s Asthma Quality of life   Parameters            Baseline     1 month         3 month        6 month
Questionnaire (AQLQ), and short and simple AQ20 (F.H. Quirk, P.W.
Jones, 1994) questionnaires were used. Significant improvement of                Daily symptoms      1.37±0.1    0.2±0.1*          0.1±0.1*    0.03±0.04*#
bronchial patency and quality of life according to all the scales was            Nighttime symptoms 1.2±0.2     0.1±0.06*           0.1±0.1*    0.04±0.04*
detected in the group of trained patients (table). The tendency to               Severity of asthma   2.3±0.1   0.6±0.1*            0.4±0.1*     0.4±0.1*
                                                                                 PFER, l/min        321.5±19.3 391.8±15.9*        418.0±16.9* 448.3±14.9*#
improvement of the quality of life was no significant in the control group.
                                                                                 FEV1,%              68.1±4.7   86.5±5.1*          88.2±4.6*    90.2±3.1*
Thus, the use of educational programs help authentically increase the
                                                                                 AQ20                12.7±1.0   7.8±1.0*           2.8±0.4*#     1.5±0.3*#
quality of asthma patient’s life.


Parameters                     Educational group             Control group       PP-346 (TR)

                      Baseline           After year   Baseline      After year   THE PREVALENCE OF ASTHMA AND ASTHMA LIKE
AQLQ-1              3.90±0.20            5.09±0.21*   3.64±0.18     4.22±0.2*    SYMPTOM AMONG SECONDARY SCHOOL STUDENTS,
AQLQ-2              3.43±0.17            5.02±0.21*   3.46±0.19     3.90±0.24    AGES RANGING 13-18 YEARS IN AFYON
AQLQ-3              3.59±0.20            4.92±0.21*   3.29±0.21     3.74±0.28
AQLQ-4              4.25±0.28            5.05±0.24*   3.66±0.27     3.82±0.27    M. Ünlü1, A. Orman 1, N. Do¤an 2
AQLQ-5              3.73±0.18            5.04±0.19*   3.52±0.17     3.92±0.24      Department of Chest Diseases, Kocatepe University, Afyon
AQ20                11.4±0.81            6.65±0.77*   11.6±0.88     10.2±0.81      Department of Statistics, Art and Science Faculty of Kocatepe University,
FEV1,%              80.6±4.83             96.2±5.0*   72.8±4.61     80.0±4.40      Afyon
PERF, l/min         325±15.8             494±17.5*    312±17.4      396±18.7*
                                                                                 The aim of this study was to determine the current and cumulative
*Significant differences from baseline                                           prevalence of asthma, allergic rhinitis, atopic dermatitis and reactivities to
                                                                                 allergen skin prick tests (SPT) among secondary school students. The data
                                                                                 at the first stage were collated through the application of the European
PP-345                                                                           Community Respiratory Health Survey questionnaire on 1400 students
                                                                                 (1366 were properly completed) registering at various school in Afyon-
INFLUENCE OF FLUTICASONE PROPIONATE ON THE                                       Turkey, in the academic year 2000-2001. At the second stage a physical
CLINICAL STATE AND QUALITY OF LIFE IN ASTHMA                                     examination and SPT were performed on 121 students. Of the students
PATIENTS                                                                         within the study group, 53 (3.9%) had experienced an asthma attack
                                                                                 within the previous 12 months, 49 (3.6%) had a past of asthma attacks and
E. Barakbaeva1, A. Sadabaeva1, C. Galieva2                                       167 (12.2%) reported wheezing attacks within the previous 12 months.
  Kyrgyz National Center of Cardiology and Internal Diseases, Bishkek,           The cumulative prevalence of asthma, rhinoconjunctivitis and dermatitis
  Kyrgyzstan                                                                     were found to be 7.46%, 8.10% and 3.5%, respectively. Asthma and
  Kyrgyz Asthma Center, Bishkek, Kyrgyzstan                                      asthma-like symptoms were found to be significantly more prevalent
                                                                                 among students who smoked. A positive SPT reaction to at least one
The aim of this research was the estimation of influence of anti-                allergen was found in 15.7% of the students. SPT positivity was 11.13% in
inflammatory anti-asthmatic agent-fluticasone propionate (FP, 800 µg             asymptomatic students, 20.3% in asthmatic students. In analysis of logistic
daily) on the clinical state, ventilatory indices and quality of life in         regression, a history of atopy, as determined in the questionnaire, was seen
bronchial asthma patients before and after 6 month treatment. In 25              to have a significant effect on SPT positivity.

90                                                                                                  TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002
 TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK                                                               POSTER PRESENTATION

PP-347                                                                             age, in both genders, of the 5448 persons, who attended the survey 2691
                                                                                   were men (49.4%) and 2757 (50.6%) were women. Results: The main age
LONG-TERM PREVENTION OF PEDIATRIC ASTHMA                                           was 38.2 years (SD=12.7 years), almost half of the study population was at
                                                                                   or under 40 years of age. The prevalance of wheezing in the last 12 months,
S. Stankovic, M. Mihajlovska, A. Sulejmani, R. Stojkovska                          diagnosis of asthma, asthma attack in the last 12 months, use of asthma
Pediatrics Pulmonology Ambulance-Medical Center Kumanovo, R. Macedonia             medicine were 20.9%, 4.5%, 4.9%, and 3.4%, respectively. Awakening
                                                                                   with chest tightness, or with shortness of breath, or with cough were
Asthma is serious health problem in childhood, constantly increasing               reported as 14.2%, 14.8%, and 22.7% respectively. The prevalence of
worldwide. Pediatrics pulmonology ambulance in Kumanovo is part of the             respiratory symptoms related asthma was statistically higher in women
vision for the Macedonian National Consensus for asthma, as well as for the        than that of men. Those who had asthma symptoms and received
organized approach and care for the children with bronchial asthma. This           medication for asthma were significantly older than those who did not
stady present our expirience in long-term prevention of pediatric asthma for 6     report these conditions. However, those who had asthma/allergic
years. We diagnosed and treated 138 children, on age to 14 years, 80 boys and      symptoms in their family members were significantly younger than others.
58 girls. Continual long-term care and review treatment were used every 3 to       Conclusions: This study demonstrates that symtoms suggestive of asthma
6 months (stepwise approach). 33 patients were treated by dinatrium                are quite common and constitute a major health problem in Sivas. The
cromoglycate, 31 by nedocromyl natrium, 59 by beclomethasone dipropionate          results of this study showed a high rate of reported symptoms but a low rate
and 15 by budesonide. Compliance was very good (low only 6%). Exellent             of diagnosis and treatment of asthma among the adult population in Sivas.
effect (without obstructions and any need of bronchodilators) was found in
39.2% of the patients. The improvement at the clinical picture with rare
obstructions in 54.8% and unsatisfactory effect was found in 6%. We conclude       PP-350
that long term prevention is the best way to help the children with asthma.
Good quality of life (no limitation on physical activites and exercise and nealy   EFFICACY OF PERORAL METHOD OF IMMUNOTHERAPY IN
normal lung function) was result of long-term asthma prevention.                   CHILDREN WITH ATOPIC BRONCHIAL ASTHMA

                                                                                   M. Bezarashvili, G. Gurgenidze2, N. Kandelaki2
PP-348 (TR)                                                                          Institute of Pediatrics, Georgia
                                                                                     Tbilisi State Medical University, Georgia
OF ASTHMA AMONG PATIENTS WITH PANIC DISORDER:                                      Evaluation of efficacy and safety of original method of immunotherapy in
A PILOT STUDY                                                                      asthmatic children, carried out with using of oro-pharingeal application of
                                                                                   allergenic tablets, prepared by consolidation technique of allergenic
Ö. Dikensoy1, H. Tutkun 2, A. Filiz 2, H. Savafl 2, N. Bayram 2, N. Tiryaki 2,      exstracts of various origin, was the propose of the study. Sixty seven
E. Ekinci2, M. Ozan 2                                                              asthmatic children aged 5-15 yr underwent the double-blind, placebo-
  Department of Chest Diseases, Medical Faculty of Gaziantep University,           controlled study. The duration of trial was 30 days. Each patient in the
  Gaziantep                                                                        study group once daily was receiving allergenic tab. perorally with 5-day
  Department of Psychiatrics, Medical Faculty of Gaziantep University, Gaziantep   lasting interval, whilst patients of placebo group were using indifferent
                                                                                   tablets in the analogous manner. Each patient was evaluated before and
Panic disorder and asthma share many common characteristics and their              after treatment course clinically and for spirometric values. According to
comorbidity is common. Patients with asthma have high rates of anxiety             the results of study it was demonstrated the clinical benifit of oral
disorders, and respiratory illness may be a risk factor in the development of      immunotherapy in study group in contrast from placebo-trialed patients
panic disorder. To investigate the possible reasons for this overlapping, 39       and observed clinical effectiveness strongly correlating with statistically
patients with panic disorders, 20 patients with asthma and 35 healthy              significant invrease in FEV1 and FVC data. According to the results of
subjects as control were prospectively evaluated. We found that allergy            study, it was authentically shown, that the long term local (oro-
confirmed by skin prick tests (41%, vs 25.7%), history of hypersensitivity         pharingeal) application of specific allergen in standard doses assosiated
to drugs or foods (23% vs 8%), and familial history of asthma (38% vs 5%)          with the expressed clinical effect for evaluated patients with bronchial
were significantly more prevalent (p<0.01) among patients with panic               asthma. This marked clinical effect was expressed as an observed
disorder compared to healthy subjects. Asthma was diagnosed in 6 (15.4%)           improvenent of clinical condition of patients(reduction of frequency of
among 39 patients with panic disorder whereas panic disorder was                   asthmatic attacks and of their gravity, positive dynamics of clinical
diagnosed in 12 (60%) among 20 asthmatics. The results of this pilot study         symptoms and signs etc.) Thus, we can conclude that oro-pharingeal
suggest that allergy and a familial history of asthma increase the risk for        method of specific immunotherapy is a good alternative to parenteral
panic disorder and multi-disciplinary approach is necessary for the                method and may be effectively used for treatment of asthmatic children.
differentiation of these two entities.
                                                                                   PP-351 (TR)
PP-349 (TR)
                                                                                   SERUM ACUTE PHASE REACTANTS IN PATIENTS WITH
S‹VAS                                                                                          1
                                                                                   M. Çal›koglu, A. Unlu 2, L. Tamer 2, B. Ulubafl 2, S. Atis2, G. Polat 2
I. Akkurt , H. Sümer , S. Özflahin , U. Gönlügür , L. Özdemir , Ö. Do¤an
         1            2            2               2             2            2     Department of Chest Disease, Medical Faculty of Mersin University, Mersin
  Department of Chest Diseases, University of Cumhuriyet, Sivas                      Department of Biochemistry, Medical Faculty of Mersin University, Mersin
  Department of Public Health, University of Cumhuriyet, Sivas
                                                                                   Backgraund: Bronchial asthma is an inflammatory disease which high num-
Objective: The main objective of our study was to assess the prevalence of         bers of cytokines play an important role in the pathogenesis of the disease.
asthma in Sivas. Desing: A cross-sectional study using a screening                 Cytokines play a crucial role in the synthesis of acute phase reactants. Aims:
questionnaire adopted from European Community Respiratory Health                   The aim of this study is to acute phase reactants (APR) levels in stable asth-
Survey (ECRHS). Participants: Adults living in Sivas, at 20-107 years of           ma patients. Methods: Fourthteen stable asthma patients and 30 apparently

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                                  91

healthy controls attended to this study. Acute phase reactants were deter-        with bronchial asthma. They were divided into two groups: first one
mined by immunoturbidometrical methods (Cobas Integra 700, Roche                  included 28 patients treated with combination of Serevent (25-50 mcg
Diagnostics, Mannheim, Germany). In addition to APR, expected force               twice per day) and Tilade (4 mg 4 times per day), second – 32 children
expiratory volume in 1. second (FEV1) values, peripheral eosinophily and          treated with combination of Serevent (25-50 mcg twice per day) and
allergic status were determined. Results: C-reactive protein (CRP), alpha 1       Flixotide (50-100 mg/kg). To detect severity of bronchoobstruction and
acid glycoprotein (AAGP) and ceruloplasmin levels were significantly high-        effectiveness management we performed peak-flowmetry twice a day.
er, whereas transferrin and haptoglobin levels were lower in patients com-        Effectiveness of treatment was assessed by improvement of physical
pared to controls (CRP: 5.77±0.8 versus 2.17±1.0g/l, p<0.05; AAGP:                changes in lungs, intensity of cough, and frequency of asthma attacks. The
1.05±0.02 versus 0.88±0.05g/l, p<0.001; seruloplasmin: 0.28±0.013 versus          results show that in the second group asthma attack developed more rarely
0.16±0.085 g/l, p<0.001, transferrin: 2.63±0.05 versus 3.19±0.0 g/l, p<0.001;     comparing to the first group and peak-flowmeter data improved quickly.
haptoglobin: 0.83±0.05 versus 1.13±0.1 g/l, p<0.01). APR levels were not          We can conclude that combination of Serevent and Flixotide is more
affected from smoking, FEV1 levels, steroid use, allergic rhinitis, atopy and     effective and can be successfully used in asthma management.
eosinophili in patients. In conclusion, differences in serum levels of APR
between patients with stable asthma and controls may be a marker of inflam-
mation in these patients. Regarding whether APRs can be used as criteria of       PP-354 (TR)
activation or not, further studies comparing patients in acute and stable
phases of asthma are needed.                                                      THE EFFICACY OF HAND MADE SPACER IN THE
                                                                                  INHALATION TREATMENT OF PATIENTS WITH ASTHMA

PP-352 (TR)                                                                       fi. K›l›çl›, C. Karl›kaya
                                                                                  Department of Chest Diseases, Medical Faculty of Trakya University, Edirne
ACTIVITY IN SERA OF PATIENTS WITH STABLE ASTHMA                                   Aims: Bronchial asthma is one of the most prevalent chronic diseases.
             1          2          3           3        3            1
                                                                                  Generally inhalation therapy is the preferred treatment method. To increase
M. Çal›ko¤lu , A. Ünlü , R. Bilgin , L. Tamer , S. At›fl , B. Ulubafl ,             the release and to decrease the deposition in the oropharyngeal region of the
A. Kan›k4                                                                         drug given with metered dose inhalers (MDI), spacers are widely used. But
  Department of Chest Disease, Medical Faculty of Mersin University, Mersin       the spacers exert cost, transportation and hygiene problems. In this study we
  Department of Biochemistry, Medical Faculty of Mersin University, Mersin        compared the efficacy of standardized factory made spacer (SFS) with the
  Department of Biochemistry, Medical Faculty of Çukurova University,             home made (HMS) one. Material and Method: Thirty-three patients with
  Adana                                                                           asthma who had mild to moderate symptoms were taken to a randomized
  Department of Biostatistics, Medical Faculty of Mersin University, Mersin       prospective and double armed crossover design. After administering
Recently, an inbalance between oxidants and antioxidants is proposed in           bronchodilator with MDI, SFS and HMS, FEV1 values were measured on
smokers and in patients with airways disease. Aim: The aim of this study was      the 10th, 20th and 60th minutes and statistically evaluated with a paired
to investigate the status of intracellular antioxidant enzymes and plasma lipid   sample student’s t test. HMS was made up of the plastic (pet) 500 cc water
peroxidation in patients with stable bronchial asthma. Method: 40 stable          bottles. Volumatic® (Glaxo-Wellcome) was used as SFS. Results: When
asthma patients and 33 healthy controls were included in this study. The          MDI alone compared to the combination of HMS and MDI, the FEV1 values
mean age of patient group and control group were 37.95±2.06 and                   were higher in the 10th, 20th and 60th minutes. FMS had significant higher
33.84±1.06 years respectively. Expected %FEV1 values in patient and control       values at the 10th and 20th minutes but the FEV1 value on the 60th minute
groups were 82.35±2.41, 96.33±1.36 respectively. In order to determine            was not significant. The difference between the basal FEV1 and the FEV1
plasma malondialdehyde and erythrocyte catalase and superoxide dismutase          after the bronchodilator was highest on the 20th minute and it is found
activities, blood samples were collected. Erythrocyte catalase activity was       15.92±4.67% with MDI, 19.71±4.84% with HMS and 20.35±6.15% with
meassured the rate of decomposition of H2O2’nin by spectrophotometrically         FMS. There were significant increases in FEV1 values on the 20th and the
at 230 nm. SOD enzyme activity was measured according to the methods of           60th minutes compared to MDI alone, on the 60th minute FEV1 increase
Marklund and Roth. The levels of serum lipid peroxidation products as             with HMS was significantly high but was not significant when compared to
thiobarbituric acid (TBA)-malondialdehyde (MDA) adducts were measured             FMS and MDI. There were not any differences between the HMS and FMS
spectrophotometrically by the method described by Yagi. Results: MDA              in increasing the FEV1 value on the 10th, 20th and 60th seconds.
levels were found to be higher than control in patients sera (p<0.007).           Conclusion: HMS are as effective as the FMS and because they can be
Superoxide dismutase activities were also higher (p<0.0001) while catalas         maintained easily, cost-effectively, disposibility and the hygienic properties,
activities were lower (p<0.0001) in patients eryhtrocytes when compared to        they must be placed in the National Asthma Treatment Guidelines.
control levels. Conclusions: Our results suggest that lipid peroxidation and
antioxidant enzyme systems are affected in patients with stable asthma
characterized by chronic airway inflammation.                                     PP-355

                                                                                  THE METHOD OF EXTRACORPORAL “LASER” –
PP-353                                                                            HEMOTHERAPY IN TREATMENT OF A BRONCHIAL ASTHMA

EFFECTIVENESS OF DIFFERENT SCHEMES IN ASTHMA                                      S. Margitich, I. Kudelya
MANAGEMENT                                                                        Dniepropetrovsk Mechnikov’s Regional Clinical Hospital, Ukraine

N. Kavlashvili, I. Chkhaidze1, N. Sapanadze1, T. Obgaidze2, D. Paradze 2,
                1                                                                 Growth of diseases the bronchial asthma and lethality from it all over the
M. Dautashvili    2                                                               world is observed. The search of new methods of treatment a bronchial
  Tbilisi State Medical University, Georgia                                       asthma is conducted. For treatment 98 patients with a bronchial asthma of
  M. Guramishvili Pediatric Clinic, Georgia                                       a combined genesis of persistent current 2 steps, in a stage of remission, in
                                                                                  the age of from 18 till 67 years, with duration of disease on the average 6.5
The aim of our study was to evaluate the effectiveness of different schemes       years were selected. The diagnosis was established on a basts: on
of bronchial asthma management. We studied 4 -15 years old 60 patients            anamnesis, the different clinical indexes and tool methods of research,

92                                                                                                    TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002
 TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK                                                               POSTER PRESENTATION

ineluding the special techniques research and provocative tests. All              ‹stanbul. Newly diagnosed asthmatic patients were investigated in adult
patients have divided into 2 groups: 1) control – 49 patients and 2)              pulmonary clinic of ‹stanbul University between 1990-2002. Only 2680 of
experienced – 49 persons. All patients received treatment: a general              them evaluated by know (1625 female and 1055 men, mean
regime, diet a table 1 15, tailed, the courses of speleotherapy and the           age=33.19±11.89) All cases were tested for atopy by prick tests with
courses of medical physical culture, especially for improvement the               standard aeroallergens. All patients were interviewed and filled a
function of respiration. By the patients of experienced group, besides was        standardized questionnaire regarding their past and present medical history
conducted the method of extracorporal “laser” – hemotherapy. The blood            and social information. 1280 of these 2680 patients (47.7%) had at least one
of the patients was processed through a peripheric catheter by heliumneon         positive prick test to specific aeroallergens tested. The most common
laser with the help of conductor (exposition 5 minutes, single doze of an         aeroallergen was Dermatophagoides pteronyssinus    being positive in 69.7% of
irradiation – 0.54 dj/cm2). On a course of treatment 10 sessions, with an         atopic patients. This is the preliminary result. Evaluation of cases is ongoing.
interval in 2 days were conducted. As a result of treatment at 81.6% of the
patients of experienced group the remission was marked during 21-24
months; while in control group at 79.6% of the patients the remission last        PP-358
during 1-4 months. Extracorporal “laser” – hemotherapy is an effective
method, especially in complex treatment of a bronchial asthma and can be          QUALITY OF LIFE IN ASTHMA PATIENTS BEFORE AND
recommended for treatment of a bronchial asthma in a stage of remission.          AFTER RESPIRATOTY REHABILITATION
This method of therapy is contra-indicated at: oncological diseases, acute
and aggravation of chronic diseases, infections and mental diseases, system       L. Isakovic
diseases of a connecting tissue, diseases of blood (except for post               Specialized Hospital “Sokobanja”, Yugoslavia
hemorrhagic and iron deficiency anemias).
                                                                                  It is very important to say that asthma is a disease of persistent inflammation,
                                                                                  not only an incidental symptom that occurs. Considering that inflammation
PP-356                                                                            in asthma is constantly present, it is clear that even an exposure to the
                                                                                  provoking factors could worsen the disease as well as the condition of the
ANTIOXIDANT AND TRACE ELEMENT COMPLEX IN                                          patient. That automatically reduces the patient’s ability for normal living
OUTPATIENT CARE OF BRONCHIAL ASTHMA                                               and derange their quality of life. Methods and Results: The studying
                                                                                  included 100 patients with bronchial asthma, 50 of them were treated with
N. Panina, N. Yakovleva, T. Kotenko, L. Danilov                                   medicament therapy and the other half treated with medicament therapy
Scientific Research Institute of Pulmonology of Medical University,               and the respiratory rehabilitation. 66 (66%) of them were women, 34 (34%)
St-Petersburg, Russia                                                             were men. Anamnesis, clinical examination, as well as the examination of
Aim: To evaluate the effect of inclusion of antioxidant and trace element         the function of lungs were thoroughly done. The “Questionaire for the
complex in basic therapy in patients with asthma. Material: 38 patients (17       quality of life in asthma - AQLQ” was also used. There was a very high
males and 11 females, mean age 42.4±2.3 years) with asthma with prevalence        statistical corelation among the changes of value of all testing spirometry
of atopic component, moderate severe, in a phase unstable remission. 12           numbers as well as the changes in the quality of life of the patients (p
patients (group 1) received only basis therapy (inhalatory beta2-agonists and     <0.001), the highest corelation was with FEV%. Dr. E. Juniper and her team
corticosteroids). 26 patients (group 2) received in addition complex of oral      have been studying the same matter. They have come to the conclusion that
antioxidants (vit. E, C, A, Se, Zn, Q-10, b-carotin) during one month.            the changing of scores of AQLQ of 0.5 shows minimal difference, 1.0
Methods: spirometry, bodypletysmography, diffusion capacity for CO (single        medium, and more than 1.5 a great change. With the method of the multiple
breath and steady state), (“MasterLab”, E. Jaeger, Germany) and blood gases       regression we can see wich changing of the spirometry elements can bring
(«AVL», Austria); antioxidant and oxidative damage parameters in                  minimal, medium or great changes in the patient’s quality of life. Our studing
peripheral blood: conjugate diene (CD), malonedialdehyde (MDA) in                 and examination showed that important clinical changes with the asthma
eritrocytes and plasma. Results: After one month of treatment in group 1          patients come when the change of total score of AQLQ comes up with the
dynamics of all functional and biochemical parameters was absent or was           following spirometry elements: FVC(L)-0.481, FVC%-9.5%, FEV1(L)-
positive, but non-significant. In group 2 we observed positive significant        0.581, FEV1%-12,9%, Tiffneau’s index - 5.2% According to Dr. E. Juniper’s
changes of the majority of lung function parameters: decrease of airflow          values, the level was satisfactory - 0.5, the patients show significant changes
limitation and RV FEV1=+0.35±0.11 l, p(<MMEF25-75=+0.41±0.16,                     in AQLQ. Summary: The conclusion could be that the patients treated
PEF=0.62 ± 0.30 l/s; 0.001; l/s, p<0.02; Rex=-0.15± 0.06 kPa/l/s, p<RV= -         remedially, together with the programme of respiratory rehabilitation have
0.33± 0.15l l, 0.02; p<0. 03); increased of VCin (+0.18±0.08 l, p<0.05) and       got better AQLQ than those treated with just remedial treatment. The
DLCO ss (+9.75±5.1% Pred.). Among of biochemical tests significantly              patients should be advised to continue with the therapy wich can help them
improved CD (-0.47±0.1 mkmol/l, p<0.05). Conclusion: The improvement              to have normal life and the quality of it.
of quality of life in patients with asthma from inclusion in basic therapy the
antioxidants results in reduction or liquidation of oxidative body-stress, that
is confirmed by the functional and laboratory tests.                              PP-359

                                                                                  DEFINING LDH AND ALFA-HBDH IN ERYTHROCYTES AND
PP-357 (TR)                                                                       PLASMA IN ASTHMATICS

ALLERGIC ETIOLOGY IN ASTHMATIC PATIENTS IN                                        V. Milanovic
‹STANBUL                                                                          Specialized Hospital “Sokobanja”, Yugoslavia

A. Utkusavas, M. Erelel, E. Durgun, Ç. Çuhadaro¤lu, T. Ece, L. Tabak              Introduction: Bronchial asthma is chronical inflammation disease, which
Department of Chest Diseases, Medical Faculty of ‹stanbul University,             is studied by many aspects (genetics, patophysiologics, biochemical
‹stanbul                                                                          diagnostics, medical treatments etc.) Considering LDH increases at
                                                                                  inflammation processes, with knowledge that -HBDH atbronchial asthma
The purpose of this study was to determine the frequency of various common        is inflammation disease, we followed the level of LDH these patients.
inhalant allergens in asthmatic patients of a pulmonary clinic population in      Defining activites of LDH and his isoensims applies mostly in diagnostics

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                                   93

of acute ischemical heart diseases (AIM), liver parenhim disease, diseases       or antibiotics at infections of urinary ways can led to reinforcement of the
of blood cells, malign diseases, as well as traumas and inflamation              short-wind. Conclusion: 1. The accompanying pathology at the patients
processes. Aim: To test and evaluate the part of biochemical parameters in       with BA in elderly age can worsen current of the basic disease. 2. The
diagnostifing and following course of disease at asthmatics. Both                elderly patients with BA are need for more careful examination for
biochemical parameters are defined in blood plasma and in chemolisate of         revealing an accompanying pathology.
erythrocytes, with tendensy to separate anaerobic metabolic changes in
erythrocyte and in whole organism. Material and Methods: Research
included 42 patients. Blood patterns from 16 recreativists - male (10            PP-362
sample) and female (6) used as control group. Statistically significant
increase of activity of these ezyms in plasma and chemolisat of washed           A COMPARISON OF PATIENT PREFERENCE FOR
erythrocytes comparing to control group is recorded in our group of 42           TREATMENT WITH ORAL MONTELUKAST OR INHALED
asthmatics. Conclusion: We may say that these biochemical parameters             BECLOMETHASONE
have important part in following course of disease at asthmatics (specially
at patients from war implicated territories) as consequence of stress.                                          2
                                                                                 B. Kamenov1, S. Pljaskic-Kamenov, T. Zaharov3
                                                                                   Department of Immunology, Pediatric Clinic, Clinical Center, Nis,
PP-360                                                                             Department of Pulmonology, Health Center, Nis, Yugoslavia
                                                                                   Department of Pulmonology, Health Center, Pirot, Yugoslavia
CORTICOSTEROID-DEPENDENT BRONCHIAL ASTHMA                                        Patient preference for treatment with oral montelukast (Singulair) or
                                                                                 inhaled beclomethasone was assessed in patients whose asthma was well-
O. Bogooudinova, R. Fassakhov                                                    controlled with low dose inhaled corticosteroid therapy in this open cross-
Department of Allergology of Postgraduate Medical Academy, Kazan,                over study. 35 stable asthmatics, FEV1 ?65% predicted were randomised by
Tatarstan                                                                        treatment sequence to montelukast (10 mg bd) and inhaled
                                                                                 beclomethasone (200-400 mcg bd) each for 4 weeks, in addition to inhaled
Objectives and Methods: We were studied the control of symptoms in 73            beta2-agonist. Existing inhaled corticosteroid was replaced at
patients with steriod-dependent bronchial asthma (women-52, men-21) at           randomisation. Assessments by the patient were reported on the
the age of 16 to 79, duration of disease from 2 to 34 years, 51 patients         questionnaire for: ease of use, likes/dislikes, and concerns for each
(70%) have treated by systemic corticosteroids more than 5 years (in most        treatment. The difference in preference in favour of tablet montelukast
cases more than 10years), 6 have treated during 3-5 years, 11 1-3 years, 5       was significant, p<0.001. Patient found montelukast easier to use than
less than 1 year. Results: Most of the patients (62%) taking systemic            beclomethasone (67%), liked montelukast more than beclomethasone and
steroids in dose 5-10mg/day of prednisolone, every third 15-20 mg/day, 8%        had fewer dislikes for montelukast compared to beclomethasone. There
25-30 mg/day. Despite of taking the high doses steroids (20-30 mg/day),          was an increased reporting of adverse events on montelukast compared to
80% of the patients were using short acting β2-adrenergic agonists about 8       beclomethasone. In conclusion, patient preference for treatment with
times a day (from 4 to 10), also they were suffering from nocturnal              tablet montelukast or inhaled beclomethasone resulted in a 2: 1 preference
symptoms every day and low FEV1 (from 27% to 78%). Only in every fifth           in favour of montelukast. This preference for tablet controller therapy may
case (14 patients) FEV1 >80%, asthmatic attacks <3 times a day, and 10 of        be of clinical value in improving patient compliance with treatment.
them have taken systemic steroids less than 10 mg/day. Conclusions:
Thus, constant treatment by systemic steroids don’t ensure the control of
bronchial asthma in corticosteroid-dependent patients.                           PP-363 (TR)

                                                                                 CT EXAMINATION OF PARANASAL SINUSES IN
PP-361                                                                           ASTHMATIC PATIENTS HOSPITALIZED IN OUR CLINIC

BRONCHIAL ASTHMA IN ELDERLY PATIENTS                                             A. Akkaya1, O. Oyar 2, Ü. fiahin2, A. Ünlü 2, H. Çobano¤lu2, Z. Örnek 2
                                                                                   Department of Chest Diseases, Medical Faculty of Süleyman Demirel
G. Derbissalina, G. Smagulova, R. Semenova                                         University, Isparta
Aktobe Government Medical Academy, Almaty Medical University, Kazakhstan           Department of Radiology, Süleyman Demirel University, Medical Faculty of
Aim: To study features of current and treatment of elderly patients with
bronchial asthma (BA). Methods: 32 patients with BA (18 men and 14               Objectives: It has been determined that most of asthmatic patients have
women) were examined, mean age was 66.8 years in men and 62.5 - in               sinus pathologies like allergic rinities and sinusitis in many studies. In our
women. Results: 11 (34.4%) patients received corticosteroid drugs                study we aimed to determine this relationship. Subjects and Methods: (27
regularly, 3 (9%) - periodically. The accompanying pathology was found           women, 6 men) totally 33 asthmatic patients, age of between 27 and 60
out at 27 patients (84%). Changes from the part of the cardiovascular            (men 48.5 years), who had been treated in our clinic were taken this study.
system were found out at 16 patients (50%), from the part of the                 Nine of the patients were light persistent, 17 of them were average and 7
gastrointestinal tract at 5 (15.6%), from the part of the renal system - at 3    of them were proved persistent asthmatic. At the end of the study, the
(9.4%) patients. The combined pathology of different organs was revealed         same radiologist who was unaware of patient’s clinics evaluated all
at 4 patients (12.5%). The combination of BA with ischaemic heart                paranasal sinuses on CT. In evaluation, septum deviation, concha
disease was observed especially often-14 patients (43.7%). So, stenocardia       hypertrophy, thickening of mucous membrane and concha bulla for nasal
was met at 5 patients (15.6%), post infarction cardiosclerosis at 5 (15.6 %),    cavity, air-fluid level, thickening of mucous membrane, retention cysts,
different disturbances of rhythm - at 4 (12.5%). Analysis: the patients          presence of polyp and mucocele for paranasal sinuses were taken into
with BA in elderly age frequently suffer from accompanying pathology.            consideration. Also, osteomeatal complexes evaluated that were free or
The defeat of the gastrointestinal tract at the part of such patients can        obstructed. Results: None of the 33 patients radiologic examinations was
cause reflux-inducting asthma. The using of some groups of anti-                 not completely normal. The most radiologically determined pathology was
arrhythmic drugs and beta-adrenoblockers at the ischaemic heart disease          thickening of mucous membrane of maxillary sinuses in 24 patients.

94                                                                                                  TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002
 TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK                                                            POSTER PRESENTATION

Concha hypertrophy in 22 patients was following it. Moreover, septum             (mean age 42.4±2.3 years) with asthma with prevalence of atopic
deviation in 20 patients, thickening of nasal mucous membrane in 8               component, moderate severe, in a phase unstable remission. 12 patients
patients and concha bulla in 5 patients were determined. There was               (group 1) received only basis therapy (inhalatory beta2-agonists and
thickening of mucous membrane in ethmoidal air sinus of 8 patients,              corticosteroids). 26 patients (group 2) received in addition complex of oral
frontal sinus of 5 patients and sphenoid air sinus of 6 patients. There was      antioxidants (vit. E, C, A, Se, Zn, Q-10, beta-carotin) during one month.
determined polyp in sphenoid sinus of 1 patient and maxillary air sinus of       Methods: spirometry, bodypletysmography, diffusion capacity for CO
2 patients. Osteoma in right frontal air sinus of 2 patients and air-fluid       (single breath and steady state), (“MasterLab”, E. Jaeger, Germany) and
level in sphenoid sinus of 1 patient were analgesic. Osteomeatal complexes       blood gases («AVL», Austria); antioxidant and oxidative damage
were free in 23 patients, narrow in 5 patients and bilateral obstructed in 5     parameters in peripheral blood: conjugate diene (CD), malonedialdehyde
patients. In sphenoid air sinus of 1 patient, there was soft tissue mass that    (MDA) in eritrocytes and plasma. Results: After one month of treatment
gives the opportunity to minimal air circulation although it fills up all        in group 1 dynamics of all functional and biochemical parameters was
sinuses. Conclusion: Our acquiring findings shows that bronchial asthma          absent or was positive, but non-significant. In group 2 we observed positive
is mostly together with paranasal sinus pathology. Considering of this           significant changes of the majority of lung function FEV1=+0.35±0.11 l,
relationship would be advantageous in treatment.                                 parameters: decrease of airflow limitation and RV (p<MMEF 25-75=+0.4±
                                                                                 10.16 l/s, pPEF=0.62 + 0.30 l/s; 0,001; <0.02; Rex=-0.15± 0.06 kPa/l/s,
                                                                                 p<RV= -0.33±0.15l l, p0.02; <0.03); increased of VCin (+0.18±0.08 l,
PP-364 (TR)                                                                      p<0.05) and DLCO ss (+9.75±5.1% Pred.). Among of biochemical tests
                                                                                 significantly improved CD (-0.47 mkmol/l, p<0.05). Conclusion: The
USING RATES AND FEATURES OF LONG ACTING BETA-2                                   improvement of quality of life in patients with asthma from inclusion in
AGONIST AND INHALED CORTICOSTEROIDS IN ASTHMA                                    basic therapy the antioxidants results in reduction or liquidation of
AND COPD PATIENTS                                                                oxidative body-stress, that is confirmed by the functional and laboratory
C. Sevinç1, E. Ceylan 1, S. fiahbaz1, F. Fidan 1, A. Hayretda¤1, O. K›l›nç1, O.
‹til1, A. C›mr›n1, E. Uçan 1, M. Gök 2, A. Akkoçlu2
  Department of Chest Diseases, Medical Faculty of Dokuz Eylül University,       PP-366 (TR)
  Medical Faculty of Dokuz Eylül University (4th Year Student), ‹zmir            ELECTROLYTE LEVELS IN PATIENTS WITH CHRONIC
                                                                                 STABLE ASTHMA
We collected all the information about 81 asthmatic and 72 COPD (total
153) patients at the time of their admission of our clinic in January-           F. Deveci, T. Turgut, G. K›rk›l, M. Muz
February 2002. All of those patients were diagnosed and classified               Department of Chest Diseases, Medical Faculty of F›rat University, Elaz›¤
according to national and international guidelines. We found out that
72.8% of asthmatic patients and 76.4% COPD patients were using inhaled           Introduction: Electrolyte disturbance especially linked to therapy with β2
long acting beta-2 agonist (LAB2A) medication. Using ratio of LAB2A in           agonist and theophylline occur during astmatic attacts, especially
mild-moderate-severe persistent asthmatics were 70.8%, 71.4% and                 hypokalemia occurs earliest. In patients with chronic asthma, the
100.0% respectively (p=0.193). In COPD cases these ratios were 73.3%,            prevalence of electrolyte disturbance and the effect of therapy on these
71.8 and 88.9% (p=0.309). 84.7% of COPD patients were using inhaled              changes is unknown. Aim: To determine the prevalence of electrolyte
corticosteroids (ICS). Using ratios of ICS in mild-moderate and severe           disturbances in patients with chronic, stable asthma, and to assess whether
COPD were 66.7%, 89.7% and 88.9% respectively (p=0.128). 68.05% of               the therapeutic agents used to treat chronic asthma have an effect on
COPD patients were using LAB2A and ICS synchronously. In asthmatic               abnormal electrolyte levels. Method: The study was performed in F›rat
patients 55.9% were using salmaterole and 44.1% were using formoterole,          University, Chest Disease Department prospectively. Thirty asthmatic
in COPD patients 60.0% were using salmeterole, 40.0% were using                  patients (of 30, 6 of them were mild, 12 moderate, 12 severe) involved in
formoterole as a LAB2A. Preferred ICS were 8.6% BDP, 63.0% FP and                the study. Demographic characteristics and therapy protocols of the
28.4% budesonide in asthmatic patients, 34.4% BDP, 45.9% FP and 19.7%            asthmatic patients were obtained and serum potassium, magnesium,
budesonide in COPD patients. As an inhalation device for LAB2A in                phosphorus, calcium, and sodium levels were measured. Results: The
asthmatic patients were 57.6% MDI, 13.6% turbuhaler, 28.8 % discus, and          mean age of patients was 48.07±12.71, the ratio of male/female was 4/26.
in COPD patients were 78.2% MDI, 5.5% turbuhaler, 9.1% discus and                In this study, 83.3% of patients were receiving inhaled steroids, 93.3% of
7.3% inhaler capsule preferred. For ICS, 66.7% MDI, 16.0% turbuhaler,            them were receiving inhaled beta2 agonist and 50% of them were
17.3% discus in asthmatic patients and 80.3% MDI, 8.2% turbuhaler and            receiving oral theophylline. Electrolyte disturbance was found in 23
11.5% discus in COPD patients were preferred. Conclusion: Both groups            patients (76.6%), 60.87% of them had one electrolyte disturbance, 39.13%
were using LAB2A in high rates. Contrary to our classical information            of them had two electrolyte disturbance. In patients with electrolyte
COPD patients were using ICS in high rates. And MDI, cheaper then                disturbance, mean values of electrolytes were: magnesium; 1.34±0.19
other inhalation devices, was being used more common in both groups.             (56.6%, n=17), calcium; 11.27±0.20 (13.3%, n=4), potassium; 2.7 (3.3%,
                                                                                 n=1) and phosphorus; 2.1±0.15 (16.6%, n=5). There was no disturbance
                                                                                 in sodium. There was no statistically significant relation between age,
PP-365                                                                           duration and severity of illness, therapy and neither patients with
                                                                                 electrolyte disturbance nor pat0ients with normal elecrolyte levels.
OUTPATIENT CARE OF BRONCHIAL ASTHMA: ROLE OF                                     Conclusion: Hypomagnesemia, hypopotasemia, hypophosphotemia and
ANTIOXIDANT AND TRACE ELEMENT COMPLEX                                            hypercalcaemia were seen in chronic stable asthmatic patients. No relation
                                                                                 was found between these findings and therapy and severity of illness. We
N. Panina, N. Yakovleva, T. Kotenko, L. Danilov                                  concluded that serum electrolyte levels must be measured routinely in
Scientific Research Institute of Pulmonology of Medical University,              patients with chronic asthma and exacerbation for avoiding any potential
St. Petersburg, Russia                                                           cardiac and respiratory hazards.

Aim: To evaluate the effect of inclusion of antioxidant and trace element
complex in basic therapy in patients with asthma. Material: 38 patients

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                              95

PP-367 (TR)                                                                       test for diagnosis exercise-induced asthma. Cold climate has important
                                                                                  effect on sportsmen from point of respiratory symptoms.
                                                                                  PP-369 (TR)
A. Ekici , S. Y›lmaz , Y. Karadeniz , A. ‹te¤inli, M. Arslan , E. Kurtipek ,
        1           1              1           1            1             1
                                                                                  PSYCHOLOGICAL STATUS IN ELDERLY ASTHMATICS
T. Kara 1, Z. Apayd›n2, S. Demir2, M. Ekici 2
  K›r›kkale University, K›r›kkale
                                                                                  Ö. O¤uztürk1, A. Ekici1, M. Arslan 1, A. ‹te¤inli, E. Kurtipek1, T. Kara 1,
  K›r›kkale State Hospital, K›r›kkale
                                                                                  Z. Apayd›n2, S. Demir2, M. Ekici 2
                                                                                    K›r›kkale University, K›r›kkale
Objective: We evaluated the presence and frequency of airway or                   2
                                                                                    K›r›kkale State Hospital, K›r›kkale
parenchymal abnormalities using high-resolution CT (HRCT) in elderly
asthmatic patients. Methods: The study group consisted of 68 stable               Objective: We evaluated the psychological status in elderly asthmatic
elderly asthmatic patients (age >60 year). None of the patients smoked.           patients. Methods: The study group consisted of 70 stable elderly
The patients were separated into two groups according to the duration of          asthmatic patients (age >60 year) and 40 age matched control group (age
symptoms (late-onset asthma, < 5 year, early-onset asthma,>5 year).               67.88±1.139. None of the patients and control group smoked. The
High-resolution computed tomography of the patients were obtained.                patients were separated into two groups according to the duration of
Histamine inhalation test was performed on patients to determine the              symptoms (late-onset asthma, <5 year; age 67.97±0.81, early-onset
level of bronchial hyperreactivity. Results: In comparison with late-             asthma, ?5 year;age 66.21±0.59). Anxiety and depression scores was
onset asthmatic patients, those with early-onset asthma had significantly         measured by HAD questionnaire. Cognitif functions was measured by mini
greater frequency of emphysema (p=0.006), bronchiectasis (p=0.039),               mental test. Hypochondriasis questionnaire was derived from the
bronchial wall-thickening (p=0.014). Patients with early-onset asthma             Minnesota Multiphasic Personality Inventory. Results: Prevalance of
were significantly more obstructive (FEV1 %; 79.44±3.85; 100.11±3.18)             depression of patients with early-onset 19 (48.7%) higher than in patients
than those with late-onset asthma, and had more hyperresponsiveness               with late-onset asthma 4 (12.9%) (p=0.00019) and in control group 2
(PD20, 0.36±0.18;1.55±0.40) (p<0.05). Conclusion: These data suggest              (5.0%). Mean anxiety, depression and hypochondriassis scores of patients
that abnormalities in HRCT in early-onset elderly asthmatics may reflect          with early-onset was higher than in patients with late-onset asthma
airway or parenchymal changes which may become irreversible over                  (p<0.05). Mean anxiety,depression and hypochondiasisis scores of patients
time.                                                                             with late-onset asthma was higher than in control group (p<0.05). There
                                                                                  was not different between the mean mental test scores of patients with
                                                                                  late-onset asthma (27.71±0.29), with early-onset asthma (27.28±0.30)
PP-368 (TR)
                                                                                  and control group (28.67±0.24) (p>0.05). Conclusion: These data suggest
                                                                                  that early-onset elderly asthmatics were more depressed, more anxious and
                                                                                  more hypochondriac than the late-onset elderly asthmatics.

H. Kaynar, M. Akgün, L. Sa¤lam, A. Mirici, M. Görgüner                            PP-370 (TR)
Deparment of Chest Diseases, Medical Faculty of Atatürk University, Erzurum
                                                                                  EFFECT ON PERCEPTION OF BRONCHOCONSTRICTION OF
The purpose of this study was to evaluate the prevalence of exercise              MODERATE-DOSE FLUTICASONE PLUS SALMETEROL IN
induced-asthma and to define related symptoms and risk factors among the          ELDERLY ASTHMATICS
symptomatic students of Sports Academy in Erzurum, a city with an about
2000 meters altitude. Firstly, a questionnaire was sent to 380 students. The      A. Ekici1, A. ‹te¤inli, T. Kara 1, E. Kurtipek1, S. Demir2, Z. Apayd›n2,

questionnaire was developed from an existing list of questions, which had         M. Arslan2, M. Ekici 2
already been used in multinational studies and was modified for this study,       1
                                                                                    K›r›kkale University, K›r›kkale
including age, sex, sports branch, smooking habit, respiratory symptoms           2
                                                                                    K›r›kkale State Hospital, K›r›kkale
(cough, shortness of breath, wheezing, chest tightness, chest pain and/or
sputum production) in relation to exercise and cold climate. Later,               We evaluate the effect of moderate-dose fluticasone plus salmeterol of
symptomatic students were invited to perform pulmonary function test              perception of bronchoconstriction in elderly and in young asthmatics.
(PFT) before and after a-six minute exercise test done at room                    Twenty-one young asthmatics (aged<60yrs) and 29 elderly asthmatics
temperature. Having 15 % decrease on post-exercise FEV1 value according           (>60 yrs), were studied. The elderly asthmatics were separated into two
to baseline values was accepted as exercise-induced asthma. The                   groups according to the duration of symptoms (late-onset asthma, < 5 year;
questionnaire were replied by 277 students (205 males and 72 females)             early-onset asthma, >5 year). 50 patients with chronic asthma were
from 15 different branches. The age range was 13-33 years. Of these               assigned to 1yr treatment with 250 ug of fluticasone propionate plus 50ug
subjects, 43% were symptomatic, 31.8% were smokers, 14.4 percent had an           salmeterol, twice daily. At entry and after 1 yr, histamine inhalation test
allergy history mostly to egg and dust. Out of symptomatic students, 60           was performed for each patient. Dyspnea was assessed by modified Borg
accepted our invite. Their average baseline FEV1 and FEV 1/FVC values             scale. The Borg score in FEV1 reduction by 20% was determined as
were 105.27±15.47 and 93. 18±14.9, respectively. Of symptomatic                   perception score 20 (PS20). Results: There were no significant differences
students 70.2% were males (41% of total male group) and 29.8% were                between mean PS20 values in the first year (1.21±0.179) and the second
female (50 percent of total female group). The most encountered                   year (1.32±0.22) for late onset elderly asthmatics (p=0.709). There were
respiratory symptoms were coughing (18.1%) and chest tightness (18.1%).           no significant differences between mean PS20 values in the first year
Chi-square test and student t test were used for statistical analysis. No         (1.45±0.142) and the second year (1.11±0.30) for early onset elderly
significant correlation was found between PFT and age, sex, smoking,              asthmatics (p=0.240). There were no significant differences between mean
having symptoms, and allergy history. After performing a six-minute               PS20 values in the first year (2.27±0.25) and the second year (2.07±0.29)
exercise test only 5 cases (3 females, 2 males) had decreased FEV1 more           for young asthmatics (p=0.341). The mean PS20 value of elderly
than 15%, and the symptoms were aggrevated by cold weather in these 5             asthmatics in the first year (1.307±0.120, 2.274±0.247; p=0001) and in
cases. In conlusion we couldn’t claim that only respiratory symptoms              the second year (1.233±0.176, 2.074±0.29; p=0.012) was lower than
coluld be related to asthma. Sympthomatic patients must undergo further           young asthmatics. Conclusion: Study suggested that perception of

96                                                                                                    TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002
 TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK                                                               POSTER PRESENTATION

bronchoconstriction in asthmatics was unaffected by the treatment of            frequent positive answers in screening questionnaire were to questions
moderete-dose fluticason plus salmeterol. Perceptions of elderly asthmatics     number 4, 1, 1.1, and 3 respectively. Regarding screening questionnaire; all of
at entry and after 1 yr were lower than young asthmatics.                       asthma patients have been woken by an attack of coughing at any time in the
                                                                                last year (question 4). 98.3% of asthma patients had wheezing or whistling at
                                                                                any time in the last year and 96.7% of them had been breathless when the
PP-371 (TR)                                                                     wheezing noise when present (questions 1, and 1.1). The percentage of
                                                                                woken by an attack of coughing at any time in the last year was found 91.6%
                                                                                in asthma patients (question 3). Additionally, the question of “Have you had
                                                                                an attack of shortness of breath in pollutant areas?” which had not taken in
                                                                                screening questionnaire, were found positive in 95% of asthma patients. This
E. Harmanc›, S. Bavbek, G. Paflao¤lu, Ö. Abado¤lu, Z. M›s›rl›gil                 rate was higher than the other questions in screening questionnaire. and it is
Department of Allergic Diseases, Medical Faculty of Ankara University, Ankara
                                                                                showed that it is important in diagnose of asthma. Questions numbered 1.2,
                                                                                2, 5, 6, 7 were less effective to determine asthma than the other questions.
Alternative therapies are used in several chronic diseases including
                                                                                Conclusion: Questions numbered 1, 1.1, 3 and 4 of screening questionnaire
asthma. In this study, we aimed to determine the prevalence of the use of
                                                                                were more valuable to find potential asthma. The question of “Have you had
alternative therapies by adult asthmatic patients. A total of 301 adult         an attack of shortness of breath in pollutant areas?” should add as fifth
asthmatic patients were recruited to the study. The patients were asked
                                                                                question. This short screening questionnaire has been formed these five
about alternative therapies including herbal products, animal products,
                                                                                questions will be more efficient to find potential asthma cases.
speleotherapy, acupuncture, psyco-religious, Turkish-baths, body massage,
yoga, taken at the last 12 months or throughout their disease. The
relationship with use of these therapies and socio-cultural and economical      PP-373
characteristics were also evaluated. Overall prevalence of alternative
treatment was 42.8% (129 patients). Herbal methods were the most                NONRESPIRATORY EFFECTS OF LONG ACTING BETA-2
common reported by 79.8% of the patients followed by speleotherapy              AGONIST AND SUSTAINED-RELEASE THEOPHYLLINE IN
(17.8%) and quails’ egg (12.4%). Tea of linden (28.2%), garden thyme            ASTHMATIC PATIENTS.
(24.3%) and stinging nettle (16.5%) were the most common reported
herbal products. Use of alternative medications were positively correlated      K. Elena, A. Zaourbek
with the patient’s age (r=0.24, p<0.0001), the duration of disease (r=0.14,     Pulmonology Research Institute, Russia
p<0.05) and disease severity (r=0.16, p<0.01). The use of alternative
                                                                                The aim of the present study was to compare influence of long acting beta-
treatment was significantly higher in those patients with acute attack and
                                                                                2 agonists and theophyllines on cardiovascular system in asthmatics. Two
hospitalization in previous year compared to those without hospitalization
                                                                                groups of patients underwent 14-day treatment by long-term beta-2 agonist
and acute attack (p<0.01). The use of alternative treatment during
                                                                                - salmeterol - S. (50 µg b.i.d.; N=17, FEV1=67.2±4.3 %pred.) and sustained-
previous year (26.2%) was associated with older age (OR: 1.02, p<0.05)
                                                                                release theophylline- Theopek- T. (300 mg b.i.d.; N=14, FEV1=65.9±4.5
and increased asthma severity (OR: 2.02, p<0.05). In conclusion,
                                                                                %pred.). Resting respiratory function, echocariographic (EchoCG)
alternative treatment use is frequent among adult asthma patients and
                                                                                parameters: SV-stroke volume, EF-ejection fraction, FS-fractional
herbal products are the most common agents among alternative treatment
                                                                                shortening, Vcf-velocity of circumferential shortening (Aloka 630), and 24-
modalities. Considering the popularity of alternative medicine and
                                                                                hour ECG and blood pressure monitoring (Microvit MT-3, Schiller) were
patients’ tendency to cease the pharmacological therapy throughout
                                                                                performed before and after treatment course. In 65% of patients received T.
alternative treatment, there is a need for patients’ education regarding the
                                                                                was found HR increase (12.1±4.2/min, p<0.01). There were no significant
importance of conventional therapies in the treatment of allergic disease.
                                                                                changes of HR in patients received S. (7.5±2.8, p>0.05). In T. treated group
                                                                                (mean theophylline plasma level 11.4±2.8 mg/l) extrasystoles were
PP-372 (TR)                                                                     registered in two patients, multiple extrasystoles - in one. An essential
                                                                                increase of EchoCG parameters was observed in T. treated patients (table).
THE EVALUATION OF AN SCREENING QUESTIONNAIRE                                    We suggest that S., as well as T., induce similar cardiovascular effects;
FOR ASTHMA PREVALENCE AND FORMATION OF A NEW                                    nevertheless S. induce less ECG abnormalities and inotropic action then T.
                                                                                Table. Changes of echocardiographic parameters after treatment (M±SD)
N. Bozkurt1, A. Bozkurt 2, E. Ekinci 3
                                                                                Group    SV (cm 3 )        EF (%)             S (%)              Vcf c-1
  Chest Clinic, Gaziantep State Hospital, Gaziantep
  Department of Public Health, Medical Faculty of Gaziantep University,         T.       3.4±2.4           6.8±2.4            3.2±1.2            0.17±0.04
  Gaziantep                                                                     S.       1.9±1.1           4.3±1.2            2.4±0.8            0.12±0.02
  Department of Chest Diseases, Medical Faculty of Gaziantep University,
                                                                                PP-374 (TR)
Purpose: A lot of studies were achieved to estimate the prevalence of asthma.
Different screening questionnaires have been used in these studies.. In this    THE EFFECTS OF SALBUTAMOL, IPRATROPIUM BROMIDE
study, we aimed the retrospective evaluation of screening questionnaire for     AND COMBINATION DRUG ON LUNG FUNCTION IN
asthma prevalence were used in 1996 and the efficiency of each questions in     PATIENTS WITH ALLERGIC AND NONALLERGIC ASTHMA
questionnaire were evaluated to determine asthma. Also a new screening
questionnairre was formed. Materials and Methods: In this study, an asthma      S. Ket, A. Çilli, T. Özdemir, C. Ö¤üfl, O. Özbudak
prevalence study achieved by Bozkurt et all in Gaziantep in 1996 was            Department of Respiratory Medicine, Medical Faculty of Akdeniz University
rewiewed. In asthma patients, the answers in screening questionnaire and        Antalya
answers in medical history was obtained in clinic were compared and the
efficiency of each questions in screening questionnaire were evaluated to       It has recently been shown that immünglobulin (Ig) E can cause
determine asthma in this study. Also a new screening questionnaire for          cholinergic hyperresponsiveness in human airways and anticholinergic
asthma was formed. Results: Among asthma patients (60 patients), the most       agents can cause more pronounced bronchodilation in subjects with high

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                                  97

than in those with low Ig E levels. However, whether this occurs in              extremely important in cure of acute asthma exacerbation (AAE). The
asthmatic patients has not been clarified. In this study, the                    purpose of our study was to investigate and compare these indices for
bronchodilating responses to 400 µg salbutamol, 80 µg ipratropium                Fenoterol HFA (Berotec N)- FHFA and Fenoterol CFC (Berotec) –FCFC.
bromide and combination drug (400/80) were studied in patients with              Randomized, parallel-group, single-dose, pilot trial in 93 adult patients
nonallergic bronchial asthma (n=47), allergic bronchial asthma (n=28)            (mean age 45.7 years, 42 male, 51 female) with AAE was observed. FEV1
and normal subjects (n=46) in a single blind, randomised study on three          was measured within first 20 minutes (in 1, 3, 5, 7, 10, 15, 20) after
separate days. Basal FEV1, median age and sex were similar in all groups.        inhalation of 100 and 200 µg FCFC and FHFA through a spacer. There
The mean increase in FEV1 in the subjects with asthma was significantly          were no significant difference between increasing of the FEV1 after 1 – 10
higher after each drug when compared control group (p<0.001). The                minutes in all groups. Whereas, we found its great growth in 20 minutes in
degree of increase in FEV1 between allergic and nonallergic asthmatic            FHFA 100 group versus FCFC 100 (average 2.53 %, p<0.01) and in FHFA
patients favoured the allergic group but did not reach statistical               200 group in comparison with FCFC 200 (average 3.35 %, p<0.01). FEV1
significance. The most pronounced bronchodilatation was noted in                 in 20 min increased by 13.49% in FCFC 200 and 14.56% in FHFA 100
patients with allergic asthma who was received salbutamol. In conclusion;        groups. So, the onset of action FCFC and FHFA has no difference.
this study demonstrated that allergic asthmatic patients responded better        Nevertheless, the bronchodilating effect of FHFA is stronger than the
in general to bronchodilator drugs. Anticholinergic agents do not superior       effect of FCFC. The effectiveness of FCFC 200 µg inhalation is comparable
than either salbutamol or salbutamol plus ipratropium bromide in patients        with FHFA 100 µg inhalation. Thus, FHFA can be used in reduced doses
with allergic asthma.                                                            during the AAE.

PP-375 (TR)                                                                      PP-377


R. Demiralay                                                                     A. Qavdullaev, G. Uzakova
Department of Respiratory Medicine, University of Süleyman Demirel, Isparta      Scientific Research Institute of Tuberculosis and Lung Disease,
This work was carried out to study the effect of asthma education on             Republic of Uzbekistan
asthma knowledge, behavior and morbidity in asthmatic patients. A
randomized double blind controlled study was conducted with 54 adults            We carry out examination of population living in Tashkent city,
with asthma followed-up at the outpatient clinic of Chest Diseases and           Samarkand area, Surkhandarya area, Republic of Karakalpakstan. We use
Tuberculosis of The Faculty of Medicine of Süleyman Demirel University.          special GINA questionnaire and analyze dates of 7715 people of Republic
Patients were randomized to the verbal (n: 17), written (n: 19), and verbal-     of Uzbekistan, 1986 of them -residents of Tashkent city, 1993 -from
written (n: 18) education groups. Knowledge of asthma was measured at            Samarkand area, 1779 -from Surkhadarya area, 1757 -from Republic of
baseline, 2 months and 1 year after education. Compliance with the               Karakalpakstan. We discover that 0.1; 7.3; 14.6; 16.3% of respondents
treatment, correct inhaler skill and admisssions of hospital in the past year    from Samarkand area, Tashkent city, Republic of Karakalpakstan,
of asthmatic patients were assessed at baseline and after 1 year. Before         Surkhandarya area accordingly complained of breathlessness during last 12
education, knowledge of asthma was less in the three education groups.           month. Analogous symptoms in the morning record 0.1%; 5.5%; 9.3%;
The ratio of compliance with the treatment was 51.9%. Twenty-four                20.4% respondents accordingly; attacks of heavy breathing during the day
(44.4%) patients had perfect inhaler skill. Thirty-eight (70.4%) patients        -0.1%; 265%; 2.8%; 14.3%; dispnea after contacts with pets 0.3; 6.0; 1.5;
used their drug regimes in non-compliance with the Consensus Report.             0.4% respondents; nocturnal bronchial asthma -0.1; 2.8; 5.1; 12.2%;
Eleven (20.4%) patients were in strict compliance with the treatment and         overburden heredity for allergic disease and bronchial asthma -0.1; 5.2;
used their drug regimes in accordance with the Consensus Report. Twenty-         13.8; 16.3% accordingly. However, diagnosis of bronchial asthma before
six (48.1%) patients were in strict compliance with the treatment and at         epidemiological investigations was officially registered only at 0.1; 0.2; 0.1;
the same time used inhaled corticosteroids. Eight (14.8%) patients had           0.2% respondents accordingly. These dates are evidence of uneven
hospitalized in the past year. After education, the mean change in               prevalence of bronchial asthma in Republic of Uzbekistan. Minimal
knowledge score was highest in the verbal-written education group. The           prevalence rate registered in Samarkand area with favorable
mean change in knowledge score at 1 year after education was lower than          environmentally sound situation; maximal prevalence rate registered in
that of the change at 2 months after education. Before and after education,      Republic of Karakalpakstan, in the region of ecocatastrophe.
the mean knowledge score was correlated with education level. After 1
year, the ratio of compliance with the treatment was 66.6% (p=0.077), the        PP-378 (TR)
ratio of the correct inhaler use was 63.0% (p=0.007) and the ratio of
hospital admissions was 11.1% (p=0.754). The results of this study suggest       EXTRACELLULAR AND INTRACELLULAR MAGNESIUM
that asthmatic patients did not have sufficient information about their          BEFORE AND AFTER BRONCHOPROVOCATION TESTING
disease, and additional information about asthma increased their asthma          IN ASTHMATIC PATIENTS
knowledge and was effective on the correct inhaler use but had no effect
on compliance with the treatment and admissions of hospital.                     M. Alpar, N. Uçar, T. Ery›lmaz, A. Pelit, B. Kurt
                                                                                 Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital,
                                                                                 Magnesium (Mg) is important in the regulation of bronchomotor tone,
                                                                                 mast cell secretion and neuromuscular conductivity, Mg deficiency is
                                                                                 associated with airway hyperreactivity and wheezing and impairment of
                                                                                 lung fuction. The aim of our study was to investigate the levels of
I. Stitsenko
                                                                                 extracellular (plasma) and intracellular (erythrocytes) Mg and its possible
Military Medical Academy, Saint-Petersburg, Russia
                                                                                 relationship with airway hyperreactivity in patients with asthma.
Both the onset of the bronchodilating effect and its dose dependence are         Methacholine challenge was performed by the dosimeter method

98                                                                                                   TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002
    TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK                                                           POSTER PRESENTATION

provocative dose causing a 20% fall in FEV1 was measured. the level of Mg         mild persistent (n=124, 43%), moderate (n=0, 35%) and severe (n=52,
in plasma and erythrocytes in 23 patients with asthma and 17 normal               3%). After 3 months regular treatment 30 of moderate asthmatic patients
subjects was studied by a calmagite colourimetric assay, both at baseline         were evaluated and treated as mild persistent. During 2 years follow-up
and when FEV 1 had fallen by 20%. In asthmatic patients, Mg levels were           period, 124 patients had no exacerbations (62%), 55 patients had one
significantly lower in erythrocytes before and after bronchoprovochation          exacerbations (28%), 16 patients had two exacerbations (8%), 2 patients
testing (p<0.0001), whereas plasma levels did not differ (p=0.43). In             had three exacerbations (1%) and two patients had four exacerbations
erythrocytes, the levels of Mg were not correlated with the degree of             (1%). 72% of all exacerbations were mild, 22% were moderate and 6%
bronchial hyperreactivity. In conclusion, low erythrocytes Mg level may be        were severe. Common cold was the most frequent precipitating factor for
associated with airway hyperreactivity in patients with asthma.                   attacks. The patients who had severe and moderate attacks had longer
                                                                                  duration of disease and older population. The percentage of attacks which
PP-379 (TR)                                                                       needed hospitalization were 9%. Conclusion: These findings suggest that,
                                                                                  asthmatic patients who have spent enough time, closely followed-up and
A RETROSPECTIVE ANALYSIS OF                                                       had proper education might have few and less severe attacks.

A. Özsancak1, fi. Akçay1, F. Öner Eyübo¤lu1, G. Ayd›n2, M. Çolak 3                 PP-381 (TR)
  Department of Pulmonary Diseases, Medical Faculty of Baflkent University,
  Ankara                                                                          COMPARISON OF ZAFIRLUKAST AND INHALER
  Department of Biomedical Technician, Medical Faculty of Baflkent                 EFFECTIVITY IN THE MILD-MODERATE BRONCHIAL
  University, Ankara                                                              ASTHMA PATIENTS
  Department of Biostatistical Sciences, Medical Faculty of Baflkent University,
  Ankara                                                                          E. Y›lmaz, H. Kutbay, S. Güven, F. Seçik, R. Dodurgal›, S. Sar›y›ld›z,
                                                                                  H. Can, A. Poluman
Aim: To examine cases with planned BPT due to the probable diagnose of            Yedikule Chest Diseases and Thoracic Surgery Training and Research
bronchial hyperreactivity (BHR); to analyse BPT positive (+) cases for            Hospital, ‹stanbul
clinical properties and comorbidities. Material and Method: Cases with
planned BPT between the years of 1998 and 2001, were grouped as BPT (+),          60 patients with mild to moderate asthma were divided into three
negative (-), BPT (+) subgroups and compared for frequency of common              subgroups. Group I received 40 mg zafirlukast whereas Group II received
respiratory symptoms, smoking history (SH), comorbidities, peripheric blood       400 to 500 mcg inhaled steroid twice-a-day. Group III received both drugs
eosinophil count (PBEC) and total immunoglobin E (Ig E) levels. %20 fall          with same doses and after 8 weeks of the treatment steroid dose reduced.
in FEV1 (forced expiratory volume in one second) with a concentration of          We assessed the clinical and functional effects of each therapy. We
methacholine less than 8 mg/ml, was accepted as BPT (+). Results: 24              concluded that; 1. 40 mg zafirlukast alone had a proven therapeutic effect
patients (pts) with FEV1 levels less than %70 of predicted FEV1 and 16 pts        on mild to moderate persistant asthma 2. Zafirlukast functionally effected
without BPT measurements were excluded from the study. From remaining             both central and periferic airways by means of changes in FEV1, PEF,
315 cases, BPT was (-) in 135 and (+) in 180, who were classified as mild (28     FEF25-75 and MEF50 values. 3. There was no significant functional
pts), moderate (103 pts), severe (49 pts) BHR. Statistically significant          difference between the steroid group and the zafirlukast group. 4. Use of
difference was found between BPT (+) and (-) groups in breathlessness and         zafirlukast might reduce the steroid dose, but the number of patients
wheeze; but not in cough and chest tightness. Between BPT (+) subgroups           enrolled in this study was not adequate to make a general statement. 5. As
there was statistically significant difference only in breathlessness. No         side effects of zafirlukast is less than steroids we suggest it a treatment of
statistically significant association was found between BPT (+) and (-), BPT      choice in high risk patients for steroid use.
(+) subgroups in SH, PBEC, and total Ig E levels. In severe BHR group,
allergic rhinitis and gastroesophagial reflux were statistically significant,
more frequent comorbidities. Conclusion: According to our study with an           PP-382
outcome of 38% negativity in indicated BPT pts; we think that
breathlessness and wheeze are highly correlated with BHR and presence of          FEATURES OF CLINIC PRESENTATION IN PATIENTS WITH
comorbidities resulting in BHR is affecting BPT positivity.                       BRONCHIAL ASTHMA AND SIMULTANEOS THYROID
                                                                                  GLAND PATHOLOGY

PP-380 (TR)                                                                       O. Ilina, V. Trofimov, V. Kagarlitskaya
                                                                                  Pavlov State Medical University, Russia
FOLLOW-UP ASTHMATIC PATIENTS                                                      34 patients were examined with chronic obstructive pulmonary diseases
                                                                                  (bronchial asthma [BA]- 26, chronic obstructive pulmonary disease -8,
F. Y›ld›z, I. Baflyi¤it, H. Boyac›, A. Ilgazl›, B. Büyükgöze, L. Yücesoy,          female -30, male - 4). They have attendant pathology thyroid gland. Most
C. fiengül, E. Y›ld›r›m                                                            of patients with BA suffered from autoimmune thyroiditis (21 - 81%). In
Department of Chest Diseases, Medical Faculty of Kocaeli University, Kocaeli      five cases bronchial asthma was associated with Graves` disease. In all
                                                                                  patients with bronchial asthma and autoimmune thyroiditis allergic
Aim: The aim of this study was to determine whether close follow-up               variant of asthma was founded out. Most of patients developed
effects the frequency of acute exacerbations in asthmatic patients. Material      autoimmune thyroiditis either same time with bronchial asthma (14%) or
and Method: We investigated the files of 199 asthmatic patients who               after 3-10 years from its beginning (61%). Clinical observation was
admitted to Kocaeli University, Pulmonary Disease Department, Asthma              evidence of serious and frequent exacerbation of bronchial asthma, which
outpatient clinic between the years of 2000-2001 and determined their             can lead to progress of hypothyroidism because of emaciation reserve of
demographic characteristics, percentage and reasons of acute                      thyroid gland. Special features of clinic presentation in patients with
exacerbations and hospitalization rates. Results: 199 asthmatic patients          chronic obstructive pulmonary disease and simultaneos disturbances of
(n=153 female, 77%; n=6 male, 23) were evaluated. Mean age was                    thyroid gland status have were not founded out.
46.6±15.2 yrs. Patients were classified as mild intermittent (n=38, 19%),

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                                 99

PP-383 (TR)                                                                         worked at beginning and in the end of therapy, every year. Beside standard
                                                                                    methods, we used skin-Prick test, determining compete IgE in serum, Elisa
ASTHMA AND ATYPICAL BACTERIAL INFECTIONS:                                           test, and determining values of IgE, IgM and IgG by partigen plates
CHLAMYDIA PNEUMONIAE, MYCOPLASMA PNEUMONIA                                          (Mancinis method). Specific immunotherapy was applied in 11 patients by
AND LEGIONELLA PNEUMOPHILIA                                                         allergen of dust mite. Results: In patients, which treated by specific
                                                                                    hiposensibilitation excellent result: 35,7% patients, very good: 21.4%, good:
A. Olut1, S. Emri 2, B. Bozkurt 2, A. Demir2, M. Artvinli2, A. Günalp2              21.4%, without effect: 14.2% and aggravate: 7.1% of all. In patients, which
  Clinical Microbiology, Hacettepe University, Ankara                               treated by classic therapy: excellent result: 7.69% patients, very good:
  Department of Chest Diseases, Hacettepe University, Ankara                        19.23%, good: 4.2%, without effect: 23.0% and aggravate: 7.65%. Middle
                                                                                    values of total IgE, in patients which treated by specific therapy, with
Respiratory infections with Mycoplasma(M) pneumonia and Chlamydia(C)                excellent and very good results had significant distinction. In patients,
pneumonia are well-defined causes of acute exacerbation of asthma. This             treated by classic medicamentous therapy, with excellent, very good, and
study was undertaken to investigate the association between infections with         good results, total IgE was declined, but distinctions is not statisticaly
these pathogens, as well as Legionella(L) pneumophili,aand expression of            significant. Conclusion: By analysis immunological features with subjective
asthma symptoms. A single throat swab specimen was taken from 72 asthma             condition and clinical manifest in patients with asthma, which were treated
patients (39 presented with an acute exacerbation and 33 had stable asthma)         by specific immunotherapy, it was concluded that high correlation exists
                                                       ,                a
and 46 controls. Bacterial infection with C.pneumoniae L. pneumophilia nd           between these features (total values of IgE) but tests for total values of
M. pneumoniaewere detected by polymerase chain reaction (PCR). C.                   immunoglobulins (IgA, IgM, IgG) are not in correlation with subjective and
pneumoniae infection was related with exacerbation of symptoms in                   clinical features. Values of IgE are of fundamental importance for discovering
asthmatic patients (23% in asthma exacerbation, 3.3% in stable asthma,              cause of complaint, evaluation and management, these values are in direct
2.2% in controls). L. pneumophilia  infection was higher in asthmatic group         correlation with subjective and clinical features.
than control group (5.5% vs. 0%). M. pneumoniae infection was not
associated with asthma (7% vs. 4.3%). C. pneumoniaeinfection should be
sought in acute asthma attack and especially if the patient is a severe
asthmatic, ampirical antibiotic treatment may be considered.
                                                                                    ATYPICAL CLINICAL PRESENTATION OF INFANT
                                                                                    ASTHMA-DIAGNOSTIC PROBLEM
                                                                                    N. Uzunovska, B. Manceva, B. Dimceva, E. Daskalova, K. Boskovska
ASTHMA MANAGEMENT ASSESSMENT IN PRIMARY                                             Institute for Respiratory Diseases in Children, Macedonia
                                                                                    The diagnosis of asthma in older children is usually relatively simple.
D. Nugmanova, V. Boborykin, A. Nugmanova, D. Kuter, G. Hafner                       Problems arise in children too young for conventional tests and in those with
ZdravPlus Project, Kazakhstan                                                       atypical picture. The infants of less than 15 months who have chronical
                                                                                    respiratory simptoms with a fluctuating level of wheese and dyspnea may
Aim: Investigate asthma management quality provided by family physicians.           have true infantile asthma or symptoms following acute viral bronchiolitis,
Method: We assessed all available outpatient charts (157) from 257 registered       some other disorder. Aim: 1. presentation of atypical clinical picture of
in family group practices (FGP) asthma patients in Zhezkazgan and Satpaev           children less than 3 years old. 2. duration of necesary time for diagnosis.
cities (177.000 citizens total). 109 PHC physicians provide care in both cities.    Methods: 62 children less than 3 years old were diagnosed asthma during last
Results: Patients visit FGP 4.8 times a year. Only 33% of cases were                year and put on prevention with topical steroides. In the follow up not one
diagnosed according GINA classification. Spirometry was done for 8% of              diagnosis was regected. 29 (46.7%) had typical clinical picture, but 33
patients. But there some practices where each third patient received this           (53.2%) were with atypical presentation. 20 (60.6%) of those were with
investigation. In 50% FGPs lung functions were not tested. Physicians do not        recurent infiltrates on x-ray, and 13 (39.39%) had fluctuating level of
use peak-flow-meters. We discovered that 30% of asthma patients are steroid         wheese and dyspnea. The time from appearance of symptoms to diagnosis in
dependent. Systemic steroids were prescribed for 37% of patients. Only 21%          atypical forms was 4 months to 2 years (average 13 months) compared with
of patients were using inhaled steroids in both cities. Discussion: FGP             average of 6 months in typical cases. Most of the children 23 (69.6%) were
physicians assess clinical symptoms without monitoring lung functions. Peak-        less than 2 years of age. Conclusion: Time needed for the diagnosis of
flow-meters are not available. Systemic steroids are preferred for asthma           asthma with atypical presentation is twice longer than for typical cases and
treatment because they are cheaper than inhaled steroids. One day treatment         more than half of the children less than 2 years old had such presentation.
cost by steroid tablets is 8-10 times less than by inhaled steroids. Conclusion :   This is due to the fact that more time for follow up is needen and the
FGP physicians do not use GINA in their practice. Cost of medications drives        necessity of excluding other important diseases in differential diagnosis.
physicians and patients to prefer systemic steroids for asthma treatment.
                                                                                    OXALATE IRRITATION IN PATIENTS WITH BRONCHIAL
SOME IMMUNOLOGIC FEATURES IN ASTHMA                                                 OBSTRUCTION

S. Djordjevic                                                                       L. Shailieva, M. Peyrova, M. Zorina, N. Pavljukova
Special Hospital “Sokobanja” Sokobanja, Yugoslavia                                  Pavlov State Medical University, Russia

Aim: Estimation immunologic features before and after therapy, beside               In order to study the role of oxalate irritation in development of
comparison with subjective and clinical features. Method: Examination               inflammatory process in the airways, 67 patients with respiratory oxalosis
included 40 patients with asthma. Study and therapy treatment worked in             and 20 healthy controls were examined and practically of healthy persons.
hospital and in department for outpatients, in time of 3.5 years. Patients          The age in both groups was 19-72 years. The patients of the main group
divided in two groups: 14 patients treated by immunotherapy and 26, which           complained on dry cough attacks, bronchial obstruction varied from latent
treted by classic medicament therapy and climatic factors. Examination              to severe, in all cases hyperoxaluria and/or urinary stone disease was found.

100                                                                                                    TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002
 TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK                                                                POSTER PRESENTATION

The patients with attributes respiratori oxalosis (Pospechova G., 1996):            were male. Their median age was 60.5±10.1 (29-85). 359 of them (86.9%)
presence for a long time dry cough attacks accompanying involuntary                 had smoking. 47 were male (79.6%) and 12 female (20.4%) of 59 cases who
urinnation, phenomenon respiratory discomfort cholelitiasy illness and - or         had asbestos exposure (14.3%). 96.5% of patients had symptomatic, the
cholediscinesy of ways; hyperoxalury and - or urolitiasisy illness;                 most common were cough (67.6%), dyspnea (61.6%), and pain (60.1%).
osteochondrosis; white colour of a leather (skin), local pigmentatione              Radiological findings were right-sided in 64.3% in chest x-ray. It was
(“freckle” on a back), red or fair-haired hair at the patients and their            observed mass shadow (42.4%), non-homogenous infiltration (38%),
relatives. The research of levels oxalate in a liquid bronchoalveol lavage by       homogenous infiltration (13.9%), and pleural effusion (5.4%). Radiological
a method infra-redspecroscopy, in daily urine on a method Sivorinovsky,             lesions were localized at upper zones (38.9%), lower zones (34%), and
condensate of exhaled air is carried out. The return parities between levels        middle zones (27.1%). The final diagnosis was performed with bronchial
of the contents oxalates in lavage (2.02±0.04 mmol/l) and daily urine               biopsy (73.5%), transthoracic needle biopsy (8.3%), bronchial lavage
(0.32±0.03mmol/l) at the patients with hyperoxalury and direct                      (4.4%), lymph node biopsy (4.1%), pleural biopsy (3.6%), open lung biopsy
dependence sign of symptoms obstruction from a level oxalate in lavage are          (2.4%), bronchial brush (1.9%), and sputum cytology (1.2%). Histological
marked and daily wet a condensate of exhaled air (5.31±0.06 mcmol/l). At            types were squamous cell carcinoma (67.2%), small cell carcinoma
the patients without attributes respiratori oxalosi the contents oxalate in         (20.4%), adenocarcinoma (9.2%), and large cell carcinoma (3.2%).
lavage has made (0.25±0.02 mmol/l), in condensate- (37±0.06 mmol/l) and
in urine - (0.16±0.03 mmol/l), at the healthy persons oxalate in condensate
- (3.6±0.07 mcmol/l), in urine- (0.10±0.04 mmol/l). Features of the
patients of the basic group are: rather favorable current bronchoobsstructive
                                                                                    ACUTE LEFT BUNDLE BRANCH BLOCK DEVELOPED IN
syndrom, without a positive effect from application broncholitilic,
                                                                                    THE COURSE OF BRACHYTHERAPY FOR BRONCHIAL
mucolitic, antibiotic, glucocorticoid of preparations; moderate or latent
obstructive of infringement of function of breath; the softly expressed
symptoms of an allergy - low eosinophil content in peripheral blood, from
                                                                                    N. Vasic1, E. Sudjic1, D. Jovanovic1, N. Pajic 1, R. Stevic2
bronchial lavage without attributes of an inflammation; a low level                 1
                                                                                      Institute for Lung Diseases and Tuberculosis, Yugoslavia
immunoglobulini A, negative or poorly positive skin allergic tests.                 2
                                                                                      Institute of Radiology, Yugoslavia

PP-388                                                                              We report the case of acute left bundle branch block (LBBB) developed
                                                                                    during the course of endoluminal brachytherapy for bronchial carcinoma.
PALLIATIVE CHEMOTHERAPY IN NSCLC - IIIB                                             TB, male, age 62, was admitted for combined transcutaneous and
                                                                                    endoluminal radiation therapy. On the basis of radiological and
G. Radosavljevic, S. Krstic, D. Jovanovic                                           endoscopical examination the diagnosis of squamous cell carcinoma of the
Institute for Lung Diseases and Tuberculosis, Yugoslavia                            left main bronchus was established. On initial presentation, his BP was
                                                                                    170/100, heart rate 100/min, and ECG showed signs for left ventricular
Aim: Evaluation of the achieved effects of the initial treatment with 2
                                                                                    hypertrophy. Chest x-ray revealed central tumorous mass and complete
chemotherapy courses in locally advanced NSCLC. Two CT courses may be
                                                                                    atelectasis of the left lung. Within 24 hours after initial treatment
considered sufficient for evaluation of tumor reactivity to cytostatics, clinical
                                                                                    (brachytherapy, TD 7 Gy) patient developed chest pain, palpitation and
assessment of the malignant process aggressiveness, as well as for the new
                                                                                    dyspnea. BP was 200/100, heart rate 100/min while ECG showed complete
decision of the further palliative treatment modalities. Methods: Clinical          LBBB. Values of cardiospecific enzymes in serum (CPK, CPK-MB, and
study comprising 120 patients, averagely aged 57 years, PS 0-2. CT was based
                                                                                    LDH) were normal. Nonsteroid anti-inflammatory drug diclophenac-sodium
on Platinum (PE protocol was apllied in the majority of our pts, less frequent
                                                                                    was introduced in therapy as well as low doses of glicocorticoides and
PV or CAP protocols). Results: Evaluation of the effects achieved after 2
                                                                                    nitroglycerin, IV. Lower ejection fraction, impaired diastolic function and
courses of the initial CT evidenced: PR in 35 (29 %), SD in 47 (39%) and
                                                                                    paradoxical septal movements were found on radionuclide ventriculography
PD in 38 (32%). Among the group with PR, in 30 (85%) the therapy was                with 99m-TcER. On the third day congestive heart failure was evident.
continued with additional 2 CT courses, 3 (9%) anderwent surgical
                                                                                    Patient was treated with cardiotonics, diuretics and ACE inhibitors and
treatment and 2 (6%) RT. In the group with SD the treatment was
                                                                                    recovered completely. ECG showed intermittent LBBB. Radiation therapy
continued with RT in 9 (19%), with CT (1-2 courses) in 12 (26%) and
                                                                                    was reintroduced on the tenth day and completed with second dose of
symptomatic treatment in 26 (55%). Out of 38 pts with PD, symptomatic
                                                                                    endoluminal and 10 sessions of transcutaneous irradiation (TD 30 Gy), with
treatment was continued in 33 (87%), and RT in 5 (13%) pts. Conclusions:            satisfactory response. ECG signs of LBBB withdrew within 2 months. We
In the conditions characterized by the limited health care resources, initial
                                                                                    will continue to evaluate the effects of radiation therapy on cardiac
treatment with 2 CT courses applied in IIIb NSCLC may be considered as a
                                                                                    conduction system and cardiac function, acute cardiac complications and
triage therapy for subsequent palliative treatment of this category of patients.
                                                                                    the mode of their prevention. Furthermore we would like to evaluate benefit
                                                                                    of NSAIDs in impairing the adverse effects of radiation therapy on the heart.
PP-389 (TR)

RETROSPECTIVE ANALYSIS OF LUNG CANCER CASES                                         PP-391 (TR)
                                                                                    INTRATHORACIC COMPLICATIONS IN LUNG CANCER AT
Ö. Do¤an1, I. Akkurt1, Z. Seyfikli2, F. Tafl 3, S. Özflahin3, U. Gönlügür3,           FIRST PRESENTATION
‹. Yüksel4
 Department of Chest Diseases, University of Cumhuriyet, Sivas                      Y. Bülbül, T. Özlü, F. Öztuna
  Department of Chest Diseases, University of Gaziosmanpafla, Tokat                  Department of Chest Diseases, Medical Faculty of Karadeniz Technical
  Department of Radiodiognostic, University of Cumhuriyet, Sivas                    University, Trabzon
  Department of Internal Medicine, University of Cumhuriyet, Sivas
                                                                                    Intrathoracic complications at    first presentation in patients with lung
Our aim was to investigate retrospectively the general characteristics of 413       cancer diagnosed at our clinic    in last two years period were evaluated
lung cancer cases diagnosed in the chest department of University of                retrospectively. Intrathoracic     changes (atelectasis, pleural effusion,
Cumhuriyet between 1994 and 2000. The most of the patients (89.1%)                  pneumonia, etc.) secondary to     lung cancer were recorded. Ninety nine

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                                101

patients with a mean age of 63.01±8.85 years were included. Tissue                 without bone metastasis were significantly greater than in patients with bone
diagnosis were small cell carcinoma in 30.5% of the cases and non-small            metastasis.And also no significant difference was observed in serum
cell carcinoma in the rest (39.0% squamous cell carcinoma, 20.7%                   concentrations of NTX and BAL between patients with one side or multiple
adenocarcinoma, 9.8% non-small carcinoma without definitive diagnosis).            sides bone metastasis. But only significant correlation was seen in serum
Intrathoracic complications were detected in 57 (57.5%) patients.                  concentration of NTX before and after pamidronate treatment. After
Atelectasis was the most common (31.3%) complication. It was total in              pamidronate treatment, NTX level significantly decreased. We decided that
2%, lobar in 3% and segmental atelectasis in 21.3%. Five percent of the            these results were related with our small and non homogenous study groups
atelectasis were due to compression of pleural effusion. Pleural effusion was      and short therapy period. But this study, may be the first study in lung cancer,
detected in 19.2% of the cases. The rate of pulmonary parenchymal                  it is important to show that NTX is useful marker in the monitoring of
metastasis were 6%. Laryngeal nerve (hoarseness) involvement were seen             bisphosphonate therapy in lung cancer patients.
in 4% of the patients. Superior vena cava involvement was also 4%. Other
complications such as lymphangitic carcinomatosis, diaphragm paralysis,
                                                                                   PP-394 (TR)
pneumonia, etc. were detected in 14.1%. When 33 cases with distant
metastasis were compared with 66 patients without metastasis;
                                                                                   THE PRESENCE OF HELICOBACTER PYLORI IN TUMOR-
complication rates were 63.6% and 54.5% respectively (p>0.05).
                                                                                   FREE SAMPLES OF BRONCHIAL BIOPSIES OF PATIENTS
According to histopathological types; the complication rates were 53.1%
                                                                                   WITH LUNG CANCER
in squamous cell carcinoma, 64% in small cell carcinoma and 64.7% in
adenocarcinoma (p>0.05). Atelectasis and pleural effusion were the most
                                                                                   E. Tabako¤lu1, fi. Altaner2, G. Alt›ay2, O. Hatipo¤lu2, T. Ça¤lar 2
common complications observed in each three histopthologic types. In               1
                                                                                     Department of Chest Diseases, Medical Faculty of Trakya University, Edirne
conclusion, we detected intrathoracic complications in more than half of           2
                                                                                     Department of Pathology, Medical Faculty of Trakya University, Edirne
the lung cancer patients at first presentation. The most common
complications were atelectasis and pleural effusion.
                                                                                   It is commonly known that Helicobacter pylori a significant factor of
                                                                                   stomach cancers. It has been shown that patients with lung cancer are
PP-392 (TR)                                                                        frequently infected with H. pylori. The aim of this study was to investigate
                                                                                   whether H. pylori leads to lung cancer. Between 1993 and 2001, 24
PULMONARY PLASMACYTOMA                                                             patients, in whose first bronchoscopies no tumor was detected while in
N. ‹lhan Mutluay, B. Özkan Bakt›k, N. Baflay, B. Berktafl, H. Bay›z,                 second bronchoscopies lung cancer was diagnosed were the subjects of our
M. Berko¤lu                                                                        study. The average age of the patients was 57±8 eight cases had small-cell
Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital,       lung cancer and the rest had non-small-cell cancer. The existence of H.
Ankara                                                                             pylori in tumor-free samples of biopsy material was checked out using
                                                                                   toulidin blue. We obserwed that any samples did not containe H. pylori.
A 57 year-old female patient complaining nonproductive cough, back pain,           Inconclusion, no evidence was found which shows that the existence of H.
dispnea for five months admitted to our hospital. In physical examination,         pyloriis a cause of lung cancer.
there was only inspiratory rales under the right scapula. Postero-anterior x-
ray demonstrated a size of 6x6 cm. homogeneous dansity superposing cardiac
line at left midzone and a size of 3x3 cm. homogeneous dansity at right            PP-395 (TR)
midzone. Using fiberoptic bronchoscopy, an endobronchial lesion was
                                                                                   METASTASIS RATIOS OF 208 LUNG CANCER PATIENTS
revealed at left main bronchus. The biopsy specimen was reported as
plasmasitoma. Multipl myeloma was investigated but Bence-Jones protein
                                                                                   F. Ökten, M. Önal Kayhan, A. Özcan, C. fiimflek
was negative and protein electrophoresis was found to be normal. The               Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital,
patient was taken to the chemotherapy programme without operation with
the diagnosis of primary pulmonary plasmacytoma.
                                                                                   In this study, we investigated the metastasis ratios of stage IV lung cancer
                                                                                   patients at diagnosis. We evaluated 21 female, 187 male totally 208 cases
PP-393 (TR)
                                                                                   retrospectively. We determined metastases in 27 of 43 patients (62.4%)
USEFULNESS OF BONE METABOLIC MARKERS IN THE                                        with small cell lung cancer (SCLC) and in 89 of 165 patients (53.9% )with
BONE METASTASIS FROM LUNG CANCER                                                   nonsmall cell lung cancer (NSCLC). Metastases were determined as 2
                                                                                   (4.6%) brain, 11 (25.5%) liver, 14 (32%) bone, 4 (9.3%) adrenal gland, 1
G. Aygençel, C. Öztürk 1, H. Paflao¤lu 2                                            (2.3%) pancreas, 1 (2.3%) contrlateral lung in SCLC patients. But, 16
  Department of Chest Medicine, Gazi University Hospital, Ankara                   (9.6%) brain, 21 (12.7%) liver, 56 (33%) bone, 6 (3.6%) adrenal gland
  Department of Biochemistry, Gazi University Hospital, Ankara                     and 5 (3%) contrlateral lung metastases were determined in NSCLC
                                                                                   patients. Though the metastatic potential of NSCLC is less than that of
The prevalance of bone metastasis from lung cancer was reported to range
                                                                                   SCLC; distant spread was demostrated at presentation in half of NSCLC
from 32% to 40%. Although bone metastasis is usually diagnosed based on
                                                                                   cases in our study. Additionally bone was the most metastatic area in
imaging studies,recently biochemical bone metabolic markers have been
                                                                                   NSCLC and SCLC patients.
investigated in bone metastasis.In this study we investigated the clinical value
of bone metabolic markers for detecting bone metastasis in patients with lung
cancer and as markers of the clinical response to therapy. Seventy lung cancer     PP-396 (TR)
patients from our clinics were evaluated to determine the usefulness of bone
metabolic markers. Both bone resorption marker N-telopeptide (NTX) and             PRIMARY THYMIC SMALL CELL CARCINOMA
bone formation marker bone specific alkaline phosphotase (BAL) were
                                                                                   B. Berktafl, N. Basay, F. Demira¤, N. Ilhan Mutluay, H. Bayiz, M. Berko¤lu
evaluated in 33 patients with and 36 patients without bone metastasis.             Atatürk Chest Diseases and Thoracic Surgery Training and
Pamidronate was also applied to 16 lung cancer patients with bone metastasis.
                                                                                   Research Hospital, Ankara
After four cycles of pamidronate therapy, we detected again bone metabolic
markers in these patients to evaluate the usefulness of these markers in the       Fifty seven years old male patient admitted to our hospital with complains
monitoring of therapy. Serum concentration of NTX and BAL in patients              of swelling of the face, neck, left arm and upper chest, dyspnea on exercise

102                                                                                                    TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002
 TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK                                                            POSTER PRESENTATION

and dizziness. He had 67.5 pack/year smoking history. Facial edema, neck         smoked 1 packet of sigarette a day for 35 years and exposure of asbestosis.
vein distension and collateral venous engorgement over the anterior chest        On his right iris a vegetative lesion was seen. On his x-ray right hilar
wall was found in physical examination. Breathing sounds were normal.            fullness, nonhomogeneous dansity over the right lobe and bilateral calcific
Right-sided upper mediastinal widening was observed in chest radiography.        plaques especially over the both diaphragms, on his thoracal CT mass with
A 5.5x3 cm sized anterior mediastinal solid mass compressed superior vena        3 cm length, right hilar and subcarinal lymohadenopathies, bilateral
cava detected in thoracic CT. Fiberoptic bronchoscopic findings were             adrenal metastasis, on his bronchoscopy a vegetative lesion narrowing 80%
normal. Biopsy was taken with right anterior mediastinotomy. Thymus              through right intermediate bronch were encountered. Small cell lung
originated small cell carcinoma reported in pathological evaluation.             cancer diagnosis is given by bronchoscopic brush and punch biopsies and
Another focus of tumor was not found. Due to malign cell were observed           cisplatine+etoposide therapy is given. On follow up low urine density,
within regressed thymus tissue and immunohistochemistry staining with            polyuria, polidypsia gave us the diagnosis of central diabetes insipidus and
leukocyte common antigen was negative, the tumor was accepted as a               hypophysial MR is checked. Neurohypophisial and infindubilar lesions
primary thymic small cell carcinoma. Patient was treated with six-course         were encountered. Radiotherapy and chemotherapy reversed the lesions
cisplatin+etoposide chemotherapy and chest irradiation. Initially nearly         and metastasis was suggested. We suggested to present the patient with
complete tumor response obtained however two years later pancreatic              small cell lung cancer metastatises to rare organ locations as hypophysis
metastasis emerged. He survived 30 months and died.                              and iris except frequent usual organ locations.

PP-397 (TR)                                                                      PP-399

                                                                                 R. Stevic, N. Vasic 2, R. Jakovic2, E. Nikolic2, S. Djuric2
F. Fidan 1, A. Akkoçlu , O. K›l›nç1, T. Canda 2                                  1
                                                                                   Institute for Radiology, CCS, Belgrade, Yugoslavia
1                                                                                2
  Department of Chest Diseases, Medical Faculty of Dokuz Eylül University,         Institute for Lung Diseases and Tuberculosis, CCS, Belgrade, Yugoslavia
  Department of Pathology, Medical Faculty of Dokuz Eylül University, ‹zmir      The purpose of this paper is to present clinicoradiological findings of
                                                                                 carcinoid tumors of the lung. During three years period eight patients, five
E.K. was 61 years old, male. He was living in Manisa and selling metal           male and three female average of 41.2 years were treated at our Institute
goods. He was treated for a week in Manisa state hospital for dyspnea that       due to carcinoid tumor of the lung. Major clinical features were recurrent
arose in a week recently. He was sent to our clinics because his complaints      pulmonary infections, hemopthysis and persistent cough. One patient had
was continuing and cough, sputum and wheezing were added. Bilateral              no symptoms except thoracic pain. Chest x-ray revealed central lesion in
respiratory sounds were diminished especially on the left side on physical       five patients and peripheral in three. CT of thorax detected enlarged hilar
examination. He was received to investigate the differential diognosis of        lymph nodes in three pts with central localized lesion and one of these had
chronic bronchitis exaserbation, lung cancer or pneumothorax. He had a           liver metastases aswell. Preoperative diagnosis of carcinoid was established
history of smoking 30 years of packet a day and chronic bronchitis for 7         by bronhoscopic biopsy in four cases, in one preoperative was carinoma
years. Tube thorachostomy was established to te left side where 50%              epidermoides and in another one hamartoma. Definitive postoperative
pneumothorax was diagnosed. Left lung expanded on control graphisies             hystologic diagnosis of carcinoid tumor was in all these six patients and in
but respiratory sounds were still not encountered. To investigate the            another two without preoperative diagnosis. The performed surgical
ethiology of unilateral bright lung, thoracal computerized tomography and        procedures were follow: four pneumonectomias, one upper left lobectomy,
bronchoscopy were done. Left upper bronchial gate was 90%                        one right lower lobectomy, one wedge resection and one explorative
consantrically narrowed. Mucosal neuroma was diognosed on                        thoracotomy. Hystologically, six (75%) resulted to be atypical and two
bronchoscopic biopsy. In literature, primary mucosal lung neuroma was            (25%) typical carcinoids.
very rare. We found it reasonable to present a patient with endobronchial
neuroma causing unilateral bright lung and pneumothorax.
                                                                                 PP-400 (TR)

PP-398 (TR)                                                                      LATE RECURRENCE IN SMALL CELL LUNG CANCER (CASE
METASTASIS                                                                       O. Türken1, F. Çiftçi 2, B. Orhan 3, H. Çermik4, E. Bozkanat 4,
                                                                                 K. Cerraho¤lu4

F. Fidan 1, A. Alacac›o¤lu, O. ‹til 2, A. Akkoçlu2, A. Hayretda¤2, E. Ada 3,     1
                                                                                   GATA Haydarpafla Training Hospital, Oncology Service, ‹stanbul
O. Saatçi4                                                                       2
                                                                                   GATA Çaml›ca Chest Diseases Hospital, Chest Disaeses Service, ‹stanbul
1                                                                                3
  Department of Chest Diseases, Medical Faculty of Dokuz Eylül University,         Ali Osman Sönmez Oncology Hospital, ‹stanbul
  ‹zmir                                                                            GATA Çaml›ca Chest Diseases Hospital, Pathology Service, ‹stanbul
  Department of Internal Medicine, Medical Faculty of Dokuz Eylül
  University, ‹zmir                                                              Small cell lung cancer (SCLC) is a disease that gives a good response to
  Department of Radiology, Medical Faculty of Dokuz Eylül University, ‹zmir      treatment but its mortality is high. Feww patients with especially extensive
  Department of Ophtalmology, Medical Faculty of Dokuz Eylül University,         disease attain long-term survival. Most of the patients are lost due to
  ‹zmir                                                                          relapses, second primary tumors and noncancer-related reasons. A fifty
                                                                                 year-old male who has been diagnosed as SCLC in the left lung and treated
S.K. 50 years old, male, retired health official. He lived in Urfa, Diyarbak›r   with chemotherapy and radiotherapy 7 years ago presented with symptoms
and Elaz›¤. His complaints were high fever and ache on the eye. He was           such as cough and dispnea. A mass was detected on thorax CT in the right
suffering from cough, sputum, starvation, loosing weight and perspiration        lung. Bronchial forceps biopsy was done. Pathological examination
during night for the last 15 days. He admitted to emergency service              revealed SCLC. Immunohistochemistry with synaptophisin confirmed the
because of continuous ache on the eye for two days. In his history he            diagnosis. The case was considered as a late relapse of SCLC.

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                            103

PP-401 (TR)                                                                       was referred to the department of pulmonary surgery for thoracotomy and
                                                                                  a right pneumonectomy was performed, which confirmed the diagnosis.
A CASE REPORT ABOUT PLEURAL THICKENING                                            On the postoperative fourth day all the skin lesions disappeared. The
DEPENDENT ON BROMOCRIPTINE                                                        patient was included in a follow-up scheme.

A. Alacac›o¤lu, A. Akkoçlu2, F. Fidan 2

 Department of Internal Medicine, Dokuz Eylül University, ‹zmir                   PP-403 (TR)
  Department of Pulmonary Diseases Dokuz Eylül University Hospital, ‹zmir
                                                                                  PRIMARY LUNG CANCER AND BRAIN METASTASIS
Bromocriptine, a dopamine agonist,is a drug which is an ergot alkaloid
derivative. It’s the therapy of choice in prolactinomas in most patients and      D. Tatar, Ö. Berktafl, E. Y›lmaz Günefl, H. Halilçolar
also used in parkinsonism. Many side effects can be seen while using              ‹zmir Chest Diseases and Thoracic Surgery Training and Research Hospital,
bromocriptine. Such as headache nausea, vomiting, postural hypotension,           ‹zmir
abdominal cramps. Occasionally, pleural efusion and rarely pleural
thickening due to bromocriptine usage also have been reported in                  We evaluated retrospectively 57 cases diagnosed as primary lung cancer with
literatures. We have a patient who was a 21-year-old woman. She was               brain metastases in our clinic between 1997-2000. There were brain
treated with bromocriptine (5 mg/day) due to pituatory adenoma since              metastases in 57 cases of total 1000 cases with primary lung cancer (5.7%).
november 1999. Then she was admitted to transspheinodal surgery. But              Of the 35 cases whose files could be evaluated 34 were male and 1 was
unfortunately, after initially succesful surgery, hyperprolactinemia has          female; and the mean age was 61.3 (range: 35-75). 14 cases (40%) had brain
recured and bromcriptine treatment in high dosage (30 mg/day) was                 metastases at the time of diagnosis and 3 of them had been operated. 11
rebegin. Then dosage also increased to 60 mg/day. In the following period         (31.4%) cases were asymptomatic; the most common symptoms were
patient suffered from dyspnea and pleural pain at right side. She is searched     dizziness (18 cases, 51.4%) and headache (12 cases, 34.2%). The
due to these complaints. Volume decrease in right hemithorax and pleural          histopathological distribution was as following; adenocarcinoma 51.4% (n:
thickening at middle and inferior zone at chest x-ray and thorax CT. Her          18), squamöz cell carcinoma %28.5 (n: 10), small cell carcinoma 20% (n: 7).
pulmonary function test was suitable for restrictive pattern. Bronchoscopy        65.7% of lung tumors localized peripherically. Brain metastases were usually
and open pleural biopsy was normal. So bromocriptine is thought as a              with N2 disease (20 cases, 57.1%) and T3 tumor (22 cases, 62.8%). The
cause of pleural thickening and this case is presented in light of literatures.   mean metastasing time was 2.1 months (0-6 months) after diagnosis. The
                                                                                  most frequent metastasing form was solitary metastasis (n: 18, 51.4%), the
PP-402 (TR)                                                                       most frequent metastasing site was parietal lobe (n: 15, 42.8%). All patients
                                                                                  had received cranial radiotherapy and symptoms had been controlled. The
A CASE OF BULLOUS PEMPHIGOID ACCOMPANIED BY                                       mean survival time of 23 patients who we could reach was 72.6 (15-150)
SQUAMOUS CELL CARCINOMA OF THE LUNG                                               days. As a conclusion; in our study, peripheric localization and
                                                                                  histopathologically adenocarcinoma were mostly determined. Although, all
             1                                 2
R. Dodurgal›, S. Sar›y›ld›z1, G. Hac›ibrahimo¤lu, S. Güven2,                      patients had received RT, the mean survival time was quite short.
                   2               2
A. Karamustafao¤lu, M. Bedirhan , A. Poluman2
  Yedikule, Chest Diseases Hospital, 3. Chest Diseases Clinic, ‹stanbul
  Yedikule Chest Diseases Hospital, 3. Thoracic Surgery Clinic, ‹stanbul          PP-404 (TR)

A case of bullous pemphigoid accompanied by squamous cell carcinoma of            A CASE REPORT OF EXTREMELY PROGRESSIVE LUNG
the lung Squamous cell carcinoma of the lung is common (30%) among                CANCER
pulmonary cancers. However, its coexistence with bullous pemphigoid is
quite rare. A seventy-five-years old farmer presented with cough, bloody          H. Günen, S. Hac›evliyagil, Z. Y›ld›r›m
sputum, weight loss, and widespread skin lesions on the hands and the             Department of Chest Diseases, Medical Faculty of ‹nönü University, Malatya
whole body. The appearance of pulmonary symptoms coincided with those
of skin lesions. A right hilar lesion was noted on posterioanterior               A sixty-four year old male patient diagnosed to have epidermoid right lung
radiograph. Chest auscultation showed crepitant rales on the right lung.          cancer a year ago was hospitalised to our clinic with the complaints of
There were bullous scaly eruptions over his entire body. On computed              cough and massive hemoptysis. From his records, it was learned that at the
tomography scan of the thorax, a solid parenchymal mass of non-                   time of diagnosis patient was evaluated as inoperable due to hepatic
homogeneous density was identified in the middle zone of the right lung,          metastasis and placed on an ambulatory chemotherapy, but the patient
extending to the posterior mediastinal lobe and mediastinal fatty planes,         interrupted the treatment with his own will after the fourth cycle. On PA
surrounding the bronchus intermedius distally and the right lower lobe            chest roentgenogram and computerised thorax tomography, there were
bronchus posterolaterally, and obliterating the superior segmental                innumerable metastatic nodules with diameters ranging from 1 to 3 cm at
bronchus of the lower lobe. Fiberoptic bronchoscopy showed a mucosal              the time of admittance. Patient stated that he had not taken any drug in the
lesion and edema in the carina separating the right upper lobe of the lung        last six months other than the analgesics which he had been utilising
and the the bronchus intermedius. The opening of the right lower lobe of          continuously for the last year, and his PA chest roentgenogram taken forty
the lung was narrowed and there were clear secretions from the basal              days before the admittance did not reveal any other lesion except the 5x6
segments. The superior segment of the right lower lobe was almost fully           cm diameter primary lesion for which the patient had been on follow-up for
occluded by mucosal infiltrations; needle aspiration biopsy and lavage            one year and paratracheal lymphadenopathy. Having no clinical finding of
specimens obtained showed no tumoral cells. Findings of the transthoracic         infection, serologic, microscopic and cultural investigations of sputum and
needle aspiration biopsy were consistent with a diagnosis of poorly               blood samples to clarify the specific-nonspecific pathogens resulted
differentiated squamous cell carcinoma of the lung. Concurrent                    negative. We intended to present the case due to the fact that those
dermatologic consultations and biopsy obtained from the skin lesions were         innumerable lesions appeared within a short period of forty days, and the
in favor of bullous dermatitis. In addition, findings of the direct               doubling time of those metastases are around 4 to 5 days which is extremely
immunofluorescent studies were in agreement with pemphigus.                       shorter than the generally accepted shortest doubling time of 20 days.
Examinations by abdominal ultrasonography, bone scintigraphy, and
cranial tomography showed no evidence for distant metastasis. The patient

104                                                                                                  TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002
 TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK                                                              POSTER PRESENTATION

PP-405                                                                             in the border of specimen and lymph nodes. The patient has been
                                                                                   followed-up for the seven month after operation. No relaps or metastasis
CLINICAL ASPECTS OF DIAGNOSIS IN PATIENTS WITH                                     were diagnosed during follow-up. Functions of the lung have significantly
LUNG CARCINOMA                                                                     improved. Surgical excision of the tumor preserving the lung tissue is the
                                                                                   procedure of choice for carcinoid tumors of the lung. Although such
Z. Nanovic, M. Trajcevska, L. Simonovska, O. Jotovska                              paranchyme-preserving excision in selected patients has high risk, it has
Institute of Lung Diseases and Tuberculosis, Macedonia                             been preferred because of high life quality after operation. Assessment of
                                                                                   preoperative tumor extention affects the therapeutic decision. In our case,
In the following study we retrospectively reviewed the hospital records of         electron CT of the lung combined with virtual broncoscopy findings have
patients (pts) with lung carcinoma (LC), admitted in our Institute during          a role in the surgical approach. Since the postoperative long term follow-
2001: 107 male and 27 female, mean age 59.4 (23-81). Hospitalization took          up results are good, therefore we presented this case.
from 4 to 67 days (mean 16.71), and time needed for confirming the diagnosis
vary from 1 to 60 days (mean 6.49). At presentation, 29 pts looked to have
non-malignant lung disease (pneumonia in 9 pts, TB in 8 pts, pleural effusion      PP-407 (TR)
in 5 pts, hydatid disease in 2 pts, bronchitis or cardiac disease in 5 pts), and
105 pts were observed as suspicious for malignant lung disease. In terms of        BRAIN METASTASIS IN LUNG CANCER: RETROSPECTIVE
diagnosis, bronchoscopy was undertaken in 131 pts (including 2 interruptions       ANALYSIS OF 44 PATIENTS
by the pts), transthoracic needle aspiration in 20 pts, peripheral node’s
aspiration in 46 pts, thoracocentesis in 24 pts, transthoracic pleural biopsy in   M. Gülhan, A. Ertürk, S. Canbakan, H. ‹nönü, E. Özy›lmaz, N. Çapan
3 pts. Previous invasive methods were performed more then once in: 29 pts          Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital,
(bronchoscopy), 4 pts (transthoracic needle aspiration), 6 pts (peripheral         Ankara
node’s aspiration), 2pts (thoracocentesis), 1 pt (transthoracic pleural biopsy).
Cytohistological diagnosis was obtained in 121 pts by: fiberbronchoscopy 101       Lung cancer is the most common cause, accounting for 40-60% of all brain
pts, transthoracic needle aspiration (10 pts), peripheral node’s aspiration (8     metastasis. Brain metastasis represent a significant cause morbidity and
pts), needle aspiration in other localization (2 pts). In 13 pts without           mortality in the patients with lung cancer. In this study, it was aimed to
convincing cytohistological finding, diagnosis was based on clinical and           analyze the lung cancer patients with brain metastasis retrospectively.
radiological feature, with other diagnostic procedures (echotomography, CT,        Fourty-four patients were included the study. Demographic characteristics
bone scintigraphy). Fiberbronchoscopy was the most helpful diagnostic tool         and therapeutic methods in all patients and survival in 33 patients were
(77.09% of bronchoscoped pts; revised approximately in every 5th patient).         evaluated. Median age was 54 (range 39 to 72) years and five patients
We do have good mean hospitalization duration and mean time needed for             (11.36%) were women. Twenty-two patients (50%) were small-cell lung
establishing of diagnosis. But, We also had extreme values in several cases        cancer and 23 (52.27%) patients had multiple brain metastasis. The mean
which are due to: waiting for diagnostic investigation in other institution and    survival time and 1 year survival rate of all patients were 7.0±7.2 months
necessity of supportive therapy in patients with poor health condition (while      and 18.46%. The mean survival time of single brain metastasis
preparing for invasive diagnostic method). Completing the diagnostic               (9.06±12.01 months) and patients with non-small cell lung cancer
procedure remains our main problem – when dismissed from our Institute, 31         (7.56±3.87 months) were much longer than multiple brain metastasis
pts were on the waiting list (in other institution) for an appointed               (5.3±5.9 months) and patients with small-cell lung cancer (6.47±8.36
investigation which was important for tha treatment proceeding.                    months) but differencies of the groups were not statisticaly significant
                                                                                   (p>0.05). Although the patients number were small in the different
                                                                                   treatment groups for comparision, the best survival time was documented
PP-406 (TR)                                                                        in the groups of combination therapy of surgery (20.3±8.6 months). In
                                                                                   conclusion, it is thought that prospective randomized trials related with
SURGICAL APPROACH TO CARCINOID TUMORS                                              treatment strategy of the patients with brain metastasis in different
                                                                                   pathological types, especially small-cell lung cancer, are needed.
H. Çakmak1, N. Songür2, A. Ergeneci2, D. Balc› 2
  Division of Thoracic Surgery, Ankara Cancer Reserch Hospital, Ankara
  Division of Chest Diseases, Ankara Cancer Reserch Hospital, Ankara               PP-408 (TR)

A forty-year-old man admitted to hospital because of dispnea persisting for        RETROSPECTIVE ANALYSIS OF OUR PLEURAL
three years. Chest radiography showed an pneomonic infiltration in lower           MESOTHELIOMA PATIENTS
lobe of the right lung and opacity in right costodiafragmatic sinus.
Computed tomography (CT) of the thorax revealed an endobronchial                   Ö. Kanat, E. Kurt, T. Evrensel, M. Demiray, G. Gönüllü, M. Arslan,
mass occluding main bronchus of the right lobe and an infitration                  S. Kahvecio¤lu, O. Manavo¤lu
containing air-broncogram and pleural effusion. Broncoscopic                       Department of Medical Oncology, Medical Faculty of Uluda¤ University, Bursa
examination showed the mass obstructing the lumen. Histopathological
examination of the specimen obtained from the mass, disclosed carcinoid            Sixteen pleural mesothelioma patients treated and followed in our clinic
tumor. Electron CT of the lung combined with virtual broncoscopy                   between 1995-2002 were evaluated retrospectively. The characteristics of
showed a solid mass that completely occluding the right main bronchus              patients were: 9 men and 7 women; median age 62 years (range, 38-80
and minimally extending to the posteromedial wall of the right                     years); stage (according to TNM classification): 8 patients stage IV, 7
intermediate bronchus 25 mm in diameter, located next to the carina. The           locally advanced (T3-4 N0-1), 1 T2 N0. 12 patient received a treatment
mass has not extented to peribronchial and para tracheal soft-tissue.              (1 palliative pleurectomy followed by chemotherapy, 11 chemotherapy
Abdominal ultrasonography, cranial CT and whole-body scintigraphy                  alone), while 4 metastatic patients were referred to supportive care only. 4
showed no metastasis. Spirometry revealed moderately obtructive and                stage IV patients received cisplatin and doxorubicin combination
restrictive ventilation defect. The patient has undergone an right                 chemotherapy regimen mean 3 cycles (1-4). All patients had disease
toracotomy and resection of raight main bronch and anastomosis of upper            progression on therapy. Median survival of this patients was 16 weeks
lobe and intermedier bronch to trachea. Histopathologic examination of             (range, 8-52), one year survival was 12%. Seven locally advanced patients
the resected specimen revealed a carcinoid tumor and no tumoral invasion           received same chemotherapy regimen. Progression was determined in 3

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                              105

patients. 3 patients had stable disease; median time to progression was 36        process in the organism. Immunoglobulins levels and complement
weeks. One patient died due to acut miyocardial infarction six weeks after        components were not correlated with stage of disease and survival time of
diagnosis. Median survival of locally advanced patients was 38 weeks              patients. However, we believe that our study, given the limited number of
(range, 4-76+), one year survival was 40%. T2 N0 patient received six             patients in each group, cannot be a precious data about the relation between
cycles cisplatin and doxorubicin regimen. After completion of                     immunoglobulin or complement components levels and clinical stage or
chemotherapy, partial response was determined. Approximately 28                   prognosis in lung cancer patients. Additional studies involving a large patient
months later, this patient died due to second primary cancer (squamous            population are needed for evaluating the role of immunoglobulin and
cell carcinoma of the lung), although primary cancer was stable.                  complement levels in the prognosis of the lung cancer patients.

PP-409 (TR)                                                                       PP-411 (TR)

MULTIPLE MASSES                                                                   PLEVRAL EFFUSIONS IN ULUDA⁄ UNIVERSITY, SCHOOL
                                                                                  OF MEDICINE, DEPARTMENT OF PULMONARY DISEASES
B. Dursun, A. Turgut, F. Demira¤, E. Gülhan, E. Sar›ca, B. Kurt                   AND TUBERCULOSIS
Atatürk Chest Disease and Thoracic Surgery Training and Research Hospital,
Ankara                                                                            B. Bahad›r, M. Karada¤, A. Ursavafl, Z. Yavuz, S. Güney, E. Ege,
                                                                                  N. Özyard›mc›
A 63-year-old man was admitted to the hospital complaining of progressive
                                                                                  Department of Chest Diseases and Tuberculosis, Medical Faculty of Uluda¤
dyspnea, cough, left side upper back pain and weight loss (20kg) for nine
                                                                                  University, Bursa
months. He was curent smoker and had enviromental asbestous exposure. He
had obvious clubbing. Chest x-ray had shown opacification located at lower        Summary: In the department of Pulmonary Disease and Tuberculosis, talc
zone of left hemithorax and augmentated acording to nine months before.           pleurodesis was used to 10 patients with malignant pleural effusions between
Pleural effusion was serous and exudate. Cytological examination of the           August 2001 and February 2002. Three of the cases were women, seven of the
effusion showed class II findings. Pleural needle biopsy not revealed accurate    cases were men. The average age of the cases was found 62.7. Three patients
diagnosis. On diagnostic thoracoscopy multiple pleural masses were seen and       were malignant mesothelioma, three patrents were squamous cell carcinoma,
surgical excision of the masses by thoracotomy. On macroscopic examination,       one patrents were adenocarcinoma in one case talc pleurodesis wasn’t suc-
the multiple masses were observed. The mass from parietal pleural surface was     cessful and repeated. Eight cases were successful. One case didn’t result
18x15x12 cm diameter and four masses resected from pericardial surface of         because pleurodesis was used recently. Our aim is to argue the approachment
parietal pleura were 16, 9, 7 and 3 cm diameter. Total weight was 2060 gr.        to the malignant plevral effusion with the results of these cases.
Microscopically the tumors were composed of uniform collagen-forming
spindle cells, which are arranged in interlacing fascicles and showed extensive
                                                                                  PP-412 (TR)
necrosis. Mitotic figures per 10 power fields were 5-6. The tumor cells were
strong positivity with CD34 and vimentin. These findings interpreted as
                                                                                  THE DIAGNOSTIC VALUE OF BRONCHOALVEOLAR
pleural fibrosarcoma in other words malignant localized fibrous tumour of the
                                                                                  LAVAGE FLUID BIOCHEMICAL MARKERS IN BENIGN AND
pleura (MLFTP). We report a case of MLFTP diagnosed postoperatively,
                                                                                  MALIGN LUNG DISEASES
notable for its rare massive size, multiplicity and paradiagmatic for the
diagnosis and therapeutic difficulties of its management.
                                                                                  Ö. Edibo¤lu, N. Kaçar, F. Tuksavul, D. Kalenci, S. Güçlü
                                                                                  Dr. Suat Seren Chest Diseases and Thoracic Surgery, Training and Reseach
PP-410 (TR)                                                                       Hospital, ‹zmir

IMMUNOGLOBULINS AND COMPLEMENT COMPONENTS                                         The aim of this study was to examine the diagnostic contribution of the
IN PATIENTS WITH LUNG CANCER                                                      ALP, LDH and urea in BAL of patients with benign and malign lung
                                                                                  disease. BAL was obtained from 63 patients. Patients were divided in two
F. Öner, I. Savafl, N. Numano¤lu                                                   groups, according to final diagnosis, 25 patients with bronchogenic
Department of Pulmonary Disease and Tuberculosis, Medical Faculty of              carcinoma, 38 patients with benign lung disease, tuberculosis (n=13),
Ankara University, Ankara                                                         pneumonia (n=18), chronic bronchitis (n=3), interstitial lung disease (n=
                                                                                  4). BAL was performed in all cases according to radiological location.
Despite the constant development of diagnostic and therapeutic methods,           Urea, ALP and LDH were measured both in BAL and serum which was
there is no specific test for patients with lung cancer that can help in          collected syncronically. In malign group urea levels were significantly
estimating prognosis of patients and monitoring follow-up. It has been shown      higher both in serum and BAL, in benign group ALP were significantly
that there is a level of change in complement components and                      higher only in BAL. The results were significant (p<0.05). LDH
immunoglobulins concentrations in many cancer groups. The clinical                determination did not differ between two groups (p>0.05).
significance of these changes for prognosis has not been exactly verified The
aim of the present study was to gain information on the prognostic value and
tumor related changes of immunoglobulins and C3, C4 in patients with lung         PP-413 (TR)
cancer. Sera from 55 patients with lung cancer [20 squamous cell ca, 10 adeno
ca, 11 nonsmall cell ca (undetermined), 10 small cell ca] and 22 healthy          OSTEOSARCOMA ENDOBRONCHIAL METASTASES
donors were assayed in order to evaluate the concentration of IgG, IgA, IgM,
IgE, C3, C4. No considerable differences were detected between the levels of      Ö. Edibo¤lu, F. Tuksavul, A. Yener, G. Ar›, S. Güçlü
immunoglobulins in patients with carcinoma of the lung versus subjects in         Dr. Suat Seren Chest Diseases and Thoracic Surgery, Training and Reseach
the control group. Considering C3 and C4 levels in serum, although the            Hospital, ‹zmir
mean values were all in normal range, C3 and C4 levels were elevated in           Pulmonary metastasis occur approximately in 30 percent of patient with
cancer patients with different cell types compared with levels in the control     malignant diseases. Pulmonary metastatic lesions are often located in the
group. Since C3 and C4 complement components belong to the acute-phase            lung parenchyma, but rarely they can be in endobronchial location. A 37-
proteins their concentration rise as a response to evaluation of the malignant    year-old male patient was admitted to the hospital complaints of cough,

106                                                                                                   TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002
 TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK                                                               POSTER PRESENTATION

weakness and left back pain. 2 years ago an osteosarcoma had been               pleural effusion. Hydroxyurea treatment (500 mg/kg) was begun for the
diagnosed on his left acetabulum and a reconstructive surgery was done.         case evaluated as pleural and pulmonary involvement of CML. In despite
He had received radiotherapy and 6 cycles of chemotheraphy. In his              of the treatment the patient resulted with death because of clinical
physical examination breath sounds were diminished on the left                  worseness and respiratory failure. We reported this case with review of
hemithorax, on the chest x-ray total atelectasis of the left lung was seen.     literature because pleural and pulmonary involvement of CML is rarely
Thorax CT scan showed a large soft tissue mass with calcifications in the       seen and has a poor prognosis.
left lung. In the bronchoscopy, a mucosal infiltration in the left main
bronchus 1 cm away from the carina and its distal part was obstructed           PP-416 (TR)
totally with a necrotic tumoral lesion. The pathology of the material was
reported as metastasis of an osteosarcoma. A patient who had been               THE EVALUATION OF EXTRAPULMONARY METASTASES
operated from an osteosarcoma with an endobronchial metastasis is               IN PATIENTS WITH LUNG CANCER
presented and because of its rare occurence.
                                                                                M. Alpar, N. Uçar, S. Turgut, T. K›ratl›, H. Lakadamyal›, B. Kurt
                                                                                Atatürk Chest Disease and Thoracic Surgery Training and Research Hospital,
PP-414 (TR)                                                                     Ankara

ENDOBRONCHIAL METASTASES: A CLINICOPATHOLOGIC                                   In our study, the evaluation of hystological type, the symptoms concerning
ANALYSIS                                                                        metastases, physical examination and laboratory findings in lung cancer
                                                                                cases with distant metastases. 214 lung cancer cases with extrapulmonary
B. Dursun, F. Demira¤, H. Bay›z                                                 metastases were taken. 47 (21.9%) of these cases were epidermoid
Atatürk Chest Disease and Thoracic Surgery Training and Research Hospital,      carcinoma, 58 (27%) were adenocarcinoma, 48 (22.4%) were un
Ankara                                                                          determined type non-small carcinoma and 61 (28.5%) were small cell
                                                                                carsinoma.In table, organ in involvements of cases according to the
A two-year retrospective analysis revaled 18 cases (8 female, 10 male) with     hystological types were shown. Totally 298 organs of metastas were
endobronchial metastases (EBM). All cases were diagnosed by                     determined. While 121 cases (56.5%) were symptomatic, in 45 cases (21%)
bronchoscopic bronchial biopsy. Primary tumors included as:                     physical examination findings and in 52 cases (24.2%) related laboratory
rhabdomyosarkom (2), bladder cancer (1), breast cancer (3), colorectal          findings were found. As a result, it was observed that most common
cancer (4), renal carcinoma (3), thyroid carcinoma (1) and malignant            metastas site was liver in SCLC, whereas it was bone in epidermoid
melanoma (1), lymphoma (3). Median interval between diagnosis of                carcinoma. In undetermined type NSCLC, mult›ple organs metastases were
primary site and those of EBM was 5 years (1-19 year) in 13 cases. EBM and      common. In cases with related laboratory findings concerning metastatic
primary tumor were diagnosed at same time in five cases. Two cases also had     cancer symptomatic or not, the bone and brain must be investigated.
other metastatic sites. The common symptoms included haemoptysis and
cough. Interestingly, three cases were asymptomatic. EBM localizations          Table. Site in involvement of the cases according to the hystological types
were detected: as followed: 7 at right sided, 10 at left sided and 1 at
bilaterally disseminated. Endoscopic appereance was polypoid in ten cases,      Metastatic site      Epidermoid Carcinoma       Adenocarcinoma     Undetermined
mucosal infiltration in the remainders. Histopathological examination           type NSCLC           SCLC        Total
revaled that epithelial tissue at surface of the tumor was detected in nine     Liver                4             6            6                  16         32
cases and four of them were metaplastic. All of them had inflammation           Brain                13            12           8                  10         43
predominantly leucocytic but one. Necrosis in ten cases, and bleeding in        Bone                 14            17           11                 11         53
four cases were also detected. In conclusion, EBM –a rare condition- can be     Adrenal gland        –             1            3                  1          5
sencronized although represents lately. Suprisingly, it can also be             Lymphadenopathy      2             3            5                  –          10
asymptomatic. It usually prefer upper lobes, especially left lung. Leucocytic   Multiple site        6             16           14                 21         59
inflammation is the most common histopathological finding.                      Others               6             3            1                  2          12
                                                                                Total                47            58           48                 61         214

PP-415 (TR)                                                                     PP-417 (TR)

                                                                                B. Ulubafl1, F. Çimen 2, T. Ery›lmaz 3, R. Bu¤dayc›4, S. Alpar4
O. Erer 1, Y. Yalç›n1, G. Görgün 2, A. Yener2, S. Akto¤u2                       1
                                                                                  Department of Chest Disease, Medical Faculty of Mersin University, Mersin
  ‹zmir Chest Diseases and Surgery Training Hospital, ‹zmir                     2
                                                                                  Atatürk Chest Disease and Surgery Center, Chest Disease Department,
  SSK Tepecik Training Hospital, ‹zmir                                            Ankara
                                                                                  Atatürk Chest Disease and Surgery Center, Biochemistry Department,
A case of 65 year-old-woman applied to our hospital with a history of             Ankara
cough, weakness and sputum production for 4 months. In the chest x-ray,         4
                                                                                  Department of Health Care, Medical Faculty of Mersin University, Mersin
the right diaphragmatic contour could not be seen well with homogeneous
infiltrations in the middle and lower zones. In the thoracic CT, pleural        Epidemiological studies show that people with low level of total
effusion and a large consolidation area with mutiple cavitations                cholesterol have a greater risk of death due to cancer, prodominantly lung
obliterating the right middle and lower lob bronchus was present. With the      cancer. The aim of our study was to evaluated serum level of total
hemogram values WBC: 24 400/ul, RBC: 2 400 000/ul, Hb: 5.9g/dl, Htc:            cholesterol, triglycerides (TG), low density lipoprotein (LDL), very low
17.8%, MCV: 72.8 haematological examination was performed and the               density lipoprotein (VLDL), high density lipoprotein (HDL), apoprotein
diagnosis of chronic myeloid leukemia (CML) was established by                  A (apo a), apoprotein B (apo (b)) and lipoprotein A (lip (a)) in newly
peripheral blood cell counting and bone marrow biopsy. Leukemic                 diagnosed lung cancer patients. Fasting level of TCH, TG, LDL, VLDL,
infiltrations were also detected in the cytological and pathological            HDL, apo a, apo b, lip (a) were measured 20 patients with newly diagnosed
examinations of the materials from bronchoscopic and pleural biopsies and       lung cancer and 20 healthy controls. Mean ages were (patient/control)

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                                   107

46±9.05/43.75±11.81, smoking habits (pack/year) 56±15/19.12±17.33,             diagnosed by FOB, 27 patients by TTIA, 10 patients by sputum cytology,
HDL concentration was 40.5±10.45/36.65±5.33 mg/dL, TCH                         5 patients by cervical LAP biopsy,6 patients pleura cytology and pleura
concentration 170.4±62.42/185.3±42.83 mg/dL, LDL concentration                 biopsy. 4 patients were diagnosed by TTIA and FOB. FOB diagnosing
102.55±54.92/122.2±40.14 mg/dL, VLDL concentration 27.35±24.54/                criteria and our findings are compared with literature.
31.7±16.06 mg/dL, TG concentration 114.35±5342/150.7±58.35 mg/dL,
apo (a) concentration 120.43±28.79/128.5±23.66 mg/dL, apo (b)
concentration 132.99±35.64/92.88±22.05 mg/dL, lip (a) concentration            PP-420 (TR)
28.97±24.60/17.59±15.23 mg/dL. There were no significant differences of
evaluated serum lipid parameters between in lung cancer patients and           A RARE INVOLVEMENT IN LUNG CANCER: IRIS
controls. In conclusion; serum lipid concentration in lung cancer patients     METASTASES
are not useful predictor for early diagnosis
                                                                               N. Songür1, H. Gökmen Soysal2, H. K›ratl›3
                                                                                 Division of Chest Diseases, Ankara Cancer Research Hospital, Ankara
PP-418 (TR)                                                                    2
                                                                                 Division of Ophthalmology, Ankara Cancer Research Hospital, Ankara
                                                                                 Department of Ophthalmology, Hacettepe University School of Medicine,
                                                                               A 51 year-old man has been diagnosed as having squamous cell carcinoma
E. Çak›r, C. Karl›kaya
                                                                               of the lung with brain metastases. He was admitted to the hospital because
Department of Chest Diseases, Medical Faculty of Trakya University, Edirne
                                                                               of redness, pain and visual impairment of his right eye. On examination,
                                                                               there were dilatation of episkleral vena, edema in cornea, a vascular mass
In a university chest diseases clinic, 567 primary lung cancer cases
                                                                               extending into pupilla through iridocorneal angle and compressing to the
diagnosed in 1992-2001, were analyzed retrospectively. Out of 533 (%94)
                                                                               iris, on right eye. Tension was 20 mmHg in right eye and 14 mmHg in left
patients which were histologically diagnosed and had full data on the files
                                                                               eye. The patient has been diagnosed as having iris metastases with clinical
were included. The presenting symptoms with relation to mean ages,
                                                                               features and appearance of the mass. The eye was treated with external beam
gender, histological type, tumor stage and past medical history were           radiotherapy. Ocular and orbital metastases are well recognized
evaluated. The mean age was 60.7±10.2 years and there were 508 (95.8%)
                                                                               complications of disseminated malignant disease. Metastatatic carcinoma
male and 25 (4.7%) female patients with 20.3 male/female ratio.
                                                                               involving the anterior ocular segment is exceedingly rare. Iris metastases is
Presenting with local symptoms were seen in % 86.5 (n=461), regional
                                                                               not common in lung cancer and, majority of the reported cases are with
symptoms in %17.4 (n=93), symptoms related to systemic metastasis in
                                                                               small cell lung cancer. Since the metastases is located in iris and the cell type
%13.7 (n=73) and systemic non-metastatik syptoms in %52.5 (n=280).             of the lung cancer is squamous, the patient has been reported as a rare case.
Presentation with regional symptoms were in small cell (SCLC) than non-
small cell lung cancer (NSCLC) and this was due to superior vena cava
syndrome (VCSS): VCSS was presented in 16/142 (10.1%) of SCLC
where 6/367 (1.6%) in NSCLC (p<0.001). There was not relationship
between presentation and T status but regional symptoms were more in N3        CLINICAL EVALUATION OF PATIENTS WITH LUNG
status (34.3% in N3 vs. 15% in non-N3, p<0.001). Systemic symptoms due
to metastasis were more frequent in M1 status (27.9% in M1 cases vs. 1.3%
in M0, p<0.001). COPD in 5.1% (n=27), tb in 9.8% (n=52), pneumonia
                                                                               Z. Nanovic, M. Trajcevska, L. Simonovska, O. Jotovska
in 4.3% (n=23), pleurisy in 1.3% (n=7), DM in 4.7% (n=25),
                                                                               Institute of Lung Diseases and Tuberculosis, Macedonia
hypertension in 7.7% (n=41), peptic ulcus in 7.7% (n=41), CAD in 5.6%
(n=30) and second malignity in 4.5% (n=24) were found in the past
                                                                               We retrospectively reviewed the hospital records of patients (pts) with
medical history of patients. We concluded that there is not significant
                                                                               lung carcinoma (LC), admitted at our Institute during 2001: 107 male and
relation between presenting symptoms and histological types but regional
                                                                               27 female, mean age 59.4 (23-81); 113 actual/ex-cigarette smokers and 21
presentation may be more in SCLC than NSCLC. High past tuberculosis
                                                                               non-smokers. 103 pts had primary LC, classified by pathologist as following
and peptic ulcer, we observed than expected in the patients’ history.          histotypes: squamous cell (47 pts), small cell (33 pts), adenocarcinoma (11
                                                                               pts), lymphangitis carcinomatosa (6pts), other (6 pts). Metastatic LC was
PP-419 (TR)                                                                    found in 4 pts. In 14 pts LC was not cytohistologicaly distinguished as
                                                                               primary or metastatic. Cytohistological diagnosis was obtained by:
THE RETROSPECTIVE EVALUATION OF LUNG CANCER                                    fiberbronchoscopy (101 pts), transthoracic needle aspiration (10 pts),
PATIENTS                                                                       peripheral lymph node’s aspiration (8 pts), needle aspiration in other
                                                                               localizations (2 pts). In 13 pts with negative/unconvincing
A. Bahad›r, G. Ortaköylü, A. Genço¤lu, S. Akbulut, H. Öztoprak,                cytohistological finding, diagnosis was based on clinical and radiological
E. Ça¤lar                                                                      feature, with other diagnostic procedures (CT, echotomography, bone
Yedikule Chest Diseases and Thoracic Surgery Training and Research             scintigraphy). At presentation, the following symptoms were reported:
Hospital, ‹stanbul                                                             cough (111 pts), chest pain (94 pts), anorexia (76 pts), weight loss (51
                                                                               pts), dyspnoea (52 pts), haemoptysis (21 pts). Metastases were found in:
                                                                               peripheral lymph node (20 pts), abdominal organs (20 pts), bones (2 pts).
120 male patients with lung cancer,that were hospitalized in our clinic,       The results of CT scanning of the chest were: LC (13 pts), LC with
between 1999 and 2001, mean age 58.92±10.91 min: 29, max: 83, are              metastatic or local chest invasion (11 pts), LC with abdominal metastases
evaluated retrospectively. The clinical stage, bronchoscopic findings,         (1pt). LC wasprevalent in male pts (4: 1), with cigarette smoking habbit.
methods used in diagnosis, cell types are evaluated. 55 (41.7%) of patients    Fiberbronchoscopy was the most helpful diagnostic tool. 109 pts
were epidermoid, 36 (27.3%) were adeno, 30 (22.7%) were small cell, 3          underwent oncologist’s treatment (in spite of 11 pts who underwent
(2.7%) were large cell. 8 (6.1%)were nonsmall cell, but cell types were not    curative ressection), wich indicates the poor management in early
defined. 35 (26.5%) of patients were in stage 3A and below, 97 (73.4%) in      diagnosis of LC. A coexistence of TB and LC should be considered (2 pts),
stage 3B and above. 120 of patients were performed FOB.80 patients were        particularly in pts proceeding radio/chemotherapy.

108                                                                                                TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002
    TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK                                                       POSTER PRESENTATION

PP-422 (TR)                                                                    PP-424

PNEUMOTHORAX                                                                   J. Stojsic
                                                                               Institute for Lung Diseases and Tuberculosis, Yugoslavia
A. Y›lmaz, D. Güneylio¤lu, S. Arslan, Ö. Uzman, Ç. Küçük, F. Küçüker
SSK Süreyyapafla Center for Chest Diseases and Thoracic Surgery, ‹stanbul       Inflammatory pseudotumors of the lung were of unknown etiology, probably
                                                                               as a postinflammatory repaired process, with variety of morphology. During
Spontaneous pneumothorax is infrequently associated with lung cancer. The      last five years in the Institute for Lung Disease and Tuberculosis twelve
estimated rate of coexistence is between 0.03 and 0.05% for primary lung       inflammatory pseudotumors were operated and patohistologic diagnosed. Six
cancer. We presented two cases with primary lung cancer having ipsilateral     males and six females were operated. They were between 18 to 73 years of
spontaneous pneumothorax. Case 1: A 67-year-old man was admitted with          age. One patient was HIV positive. Chest x- ray examinations or CT scans
complaints of chest pain and dyspnea present for 7 days in August 2001. He     usually showed well limited nodular masses in the lung. Preoperative
was a heavy smoker. The chest x-ray film showed a cavitary lesion of left      bronchoscopies or percutaneous needle biopsies of the lung, when were
middle lung field and a ipsilateral pneumohydrothorax. Computed                made, showed no signs of inflammatory pseudotumors. Their measures were
tomography demonstrated a cavity and infiltrative shadows in left upper lobe   from 40 mm to 110 mm, requiring a kind of resections: seven segmental,
and ipsilateral pneumohydrothorax. Hydropneumothorax was treated by            three lobar and two pulmonal. These pseudoneoplasms were firm,
chest tube drainage. Fiberoptic bronchoscopy revealed a tumor obstructing      uncapsulated, white-gray nodes, often involved pleura, soft tissue of
the apicoposterior segment bronchus of left upper lobe and a biopsy            mediastinum and regional lymphnodes. On the frozen sections during seven
specimen was diagnostic of nonsmall cell carcinoma. The cancer was             operations benign morphology of the lesions was confirmed. Histologic
categorized as stage IB (T2N0M0) and was treated with irradiation because      features were similar to fibroma, fibrous histiocytoma and plasmacytoma,
he refused thoracotomy. Case 2: A 52-year-old man presented with               depending of the main cellular component. On routine H&E stains there
complaints of cough and chest pain in December 2001. He was a heavy            were lack of mitoses, nuclear atypia and no or minimal necrosis.
smoker. His chest x-ray demonstrated a mass of left hilum and ipsilateral      Histochemical and immunohistochemical stains confirmed fibruos origin
pneumothorax. After pneumothorax persisted for 10 days, reexpansion            (van Gieson, Masson trichrome, vimentin, HLA-DR, lysosime). The plasma
occurred spontaneously. Fiberoptic bronchoscopy revealed a tumor               cells were polyclonal, positive for or lambda- or kappa-light chain and
obstructing the left upper lobe bronchus. Bronchoscopic biopsy was             lymphocytes were of both T and B population. Clinical and pathological
interpreted as adenocarcinoma. The tumor was categorized as stage IIIB         aspects suggested that these lesions were more similar to neoplasms than
(T4N0M0). He is treated with irradiation. In conclusion, spontaneous           postinflammatory processes. In all operated cases the survival were excellent
pneumothorax may be present in patients with primary lung cancer. We           even where the residual or recured tumors were found in mediastinum.
conclude that spontaneous pneumothorax may be due to rupture into pleural
surface of overinflated alveoli caused by the check-valve mechanism of the
partial bronchial obstruction in our cases.                                    PP-425 (TR)

                                                                               A CASE OF A PULMONARY HYALINIZING GRANULOMA
PP-423 (TR)
                                                                               A. Çakan1, K. Turhan1, U. Ça¤›r›c›1, A. Veral2, M. Erdinç 3, Ö. Bilkay 3
BRONCHITIS INDEX AND MUCOSAL BIOPSY FINDINGS IN                                 Department of Thoracic Surgery, Medical Faculty of Ege University, ‹zmir
PATIENTS WITH CHRONIC BRONCHITIS                                                 Department of Pathology, Medical Faculty of Ege University, ‹zmir
                                                                                 Department of Chest Diseases, Medical Faculty of Ege University, ‹zmir
D. Köksal1, D. Karnak 2, O. Kayacan 2, S. Beder2, S. Erekul3
  Atatürk Chest Diseases and Thoracic Surgery Center, Ankara                   Pulmonary hyalinizing granuloma (PHG) is a rare benign pulmonary
  Department of Chest Diseases and Tuberculosis, Medical Faculty of Ankara     pathology characterized by bilaterally multiple pulmonary nodules. A 36-
University, Ankara                                                             year-old woman had cough and chest pain. She had no history of significant
  Department of Pathology, Medical Faculty of Ankara University, Ankara        disease. Physical examination was normal as well as routine blood
                                                                               biochemistry. A standard chest roentgenogram showed multiple bilaterally
Chronic bronchitis (CB) is a clinical syndrome, defined by excessive mucus     pulmonary nodules. Computed tomography (CT) of the chest confirmed
secretion in the bronchial tree and by chronic or recurrent cough. The         bilaterally eight parenchymal nodules, in which one of them was calcified.
pathologic findings of CB are characterized by submucosal gland                Serology of hydatid disease and tuberculin-skin test were negative.
hypertrophy, smooth muscle hypertrophy, goblet cell metaplasia, airway         Bronchofiberscopy was normal, microbiological studies of the
wall fibrosis and inflammation. To investigate the correlation of              bronchoalveolar lavage specimen were negative for acid-fast bacilli and
inflammatory changes on fiberoptic bronchoscopy (FOB) as visually              bacteria. No malignant cells were detected in the bronchial washings.
quantified by bronchitis index (BI) with the mucosal biopsy findings of        Abdominal CT, ultrasonographies of thyroid and breast were performed to
patients with CB, bronchoscopy and endobronchial mucosal biopsies were         rule out metastatic disease and all were found to be normal. Eventually,
performed in 14 smoking CB subjects and 8 normal nonsmoking controls.          thoracic surgical procedure was planned for diagnosis. Since
Subjects with CB had a significantly high BI (p<0.05), hypoxemia (p<0.05)      videothoracoscopy failed to explore the lesions on the left lung, one of the
and significant airflow limitation determined by measurements of FEV1          portal incisions was extended to a 5-cm-minithoracotomy incision, and then
(p<0.05), FEV1/FVC (p<0.01), FEF25-75 (p<0.05). Submucosal fibrosis            two nodules of which 0.7 and 1.1 cm in diameter were excised by wedge
(p<0.01) and smooth muscle hypertrophy (p<0.05) were the prominent             resection. The histopathological examination of the specimen revealed
findings in the mucosal biopsies of CB subjects in comparison with the         PHG. The nodules consisted of hyalinizing collagenous center surrounded by
controls. The correlation analysis with BI and mucosal biopsy findings did     chronic granulomatous inflammation. Granulomatous reaction included
not show any statistical significance. The findings of the present study       lymphocytes, plasmocytes, fibroblasts and occasionally Langhans-type
suggest that visually determined BI on FOB may be a valuable method for        multinuclear giant cells. After an uneventful postoperative period of five
determining the bronchial inflammation in CB subjects.                         days, the patient was discharged. During 20 months of follow-up, the
                                                                               patient’s chest x-ray finding and clinical condition have remained stable. In

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                           109

conclusion, clinicians should remember to include PHG in the differential       PP-428
diagnosis of multiple bilaterally pulmonary nodules.
                                                                                BRONCHODILATORS AND IMMUNOMODULATORS IN THE
                                                                                BASIS THERAPY OF THE CHRONIC OBSTRUCTIVE
PP-426                                                                          DISEASES OF THE LUNGS

CLINICAL-MORPHOLOGICAL ANALYSIS OF PATIENTS                                     O. Annadyrduev, B. Jumaew, R. Hasanowa
WITH PNEUMOCONIOSES AND PROFESSIONAL CHRONIC                                    Turkmen State Medical Institution, Turkmenistan
                                                                                Under the hot climate of the Arid zone of Turkmenistan chronic obstructive
I. Dvorakovskaia, B. Lisochkin, G. Orlova, A. Bazhanov                          diseases of lungs (CODL) are developed mainly under the pathogenic
St. Petersburg State Medical University, Russia                                 influence of the micro- and macroecology risk factors, i.e. secondary
                                                                                immunodeficiency (O. A. Annadurdyew, 1991), but tobacco smoking in
The aim of the study was to examine clinical and morphological features of      the European countries (AS Bust, 1995). To improve the efficiency of
patients suffering from pneumoconioses and professional COB. Material and       treatment of these patients by the recommendation of the European
Methods: We examined 30 patients with pneumoconioses (13 with silicosis,        Respiratory Society and the American Thoracic Society in the basis therapy
17 with pneumoconiosis of welding workers) and 25 with PCOB. Cytologic          of CODL the combined bronchodilator – berodual and taking into account
examination was carried out in all patients; analysis of transbronchial lung    the factures of CODL under the terms of Turkmenistan, the remedies
biopsy material in 49, analysis of material obtained under video assisted       improwing the local reactivity (helium arsenide semiconducting lazer –
thoracoscopy or by open lung biopsy in 15 patients. Spectral analysis of BAL    HASL in the peribronchial zone) and the general reactivity (5% licorice
fluid and lung tissue was performed in 17 cases. Results: The polarizing        root extract (LRE) inside) were used. To estimate the efficiency the clinico-
microcopy revealed macrophages containing birefringent inclusions. In           immunologic showings of 48 patients with CODL treated with the
silicosis, morphologic changes were of diffuse granulomatous character;         traditional method (TM) and 82 treated with methods: berodual+HASL;
pneumoconiosis of welders was characterized by alveolitis with progressive      berodual+LRE; berodual+HASL+LRE worked out by us.While treating
interstitial fibrosis and reactive hyperplasia of alveolar epithelium. In two   CODL berodual combined with HASL and LRE has improved considerably
patients the computed tomography revealed the honeycombing lung picture.        early the general state of the patients the general clinical manifestation of
The spectral analysis allowed to precise a pathogenetic role for                the diseases have disappeared, the bronchial permeability has improved in
microelements (Zn, Cr, Pd, Zr and others). In PCOB there were                   comparison with the patients treated with TM treated with berodual only.
distinguished phases of remission and exacerbation: the morphologic picture     The best clinical effect was received while treating the patients of CODL
of catarrhal bronchitis with hyperplasia of caliciform cells was observed in    with berodual+HASL+LRE. Berodual combined with HASL improved the
exacerbation phase; predominance of atrophic bronchitis characterized the       local antiinfections protection of the broncho-pulmonary system, while LRE
remission phase. The progression of bronchitis and bronchiolitis in small       recovered the general immune reactivity. Thus, under the terms of the arid
bronchi leaded to the development of centriacinar emphysema. Conclusion:        zone the treatment of the patients of CODL including immunomodulators
The data obtained are important from the viewpoint of differential diagnosis    combined with bronhodilators (cholinolitics) in the basis therapy is
between two forms of professional pathology of lungs, as well as of better      pathogenetically substantiated. Such kind of therapy considerably improved
understanding of their pathogenetic mechanisms.                                 the effeciency of the treatment of CODL patients.

PP-427 (TR)                                                                     PP-429

SHOWING INTERSTITIAL LUNG INFILTRATES ON                                        DISEASE
                                                                                S. Kostianev, V. Hodgev, A. Hristova, B. Dobreva, M. Tokmakova, P.
H. Al Ahdab, S. Karakurt, P. Golabi, B. Ceyhan, T. Çelikel                      Mandulova, D. Iluchev
Department of Chest Diseases, Marmara University, ‹stanbul                      Medical University, Plovdiv, Bulgaria

A 22-year-old jobless male patient, having a history of early exhaustion        The aim of this study was to analyse the verbal descriptors of dyspnea in
since being 2 years old; presented with progressively worsening dispnea, and    patients with chronic obstructive pulmonary disease (COPD), bronchial
a 5 kg weigth loss. He did not discribe any of fever, night sweat, cough or     asthma (BA) and chronic heart failure (CHF). Complete pulmonary
sputum production, but he had cynosis and clubbing. Diffuse micronoduler        function testing was carried out in 100 patients with COPD (FEV1%
infiltrations were seen on thorax tomography. The partial oxygen pressure       predicted=34±14%), 50 with BA (* FEV1 after salbutamol >200 mL) and 50
while breathing room air was 57 mmHg. Signs of dilated right heart              with CHF (NYHA classes II – III and LVEF<40%). The assessment was
chambers and pulmonary hypertension, were found on echocardiography             made with the Bulgarian version of the scale of Simon, PM et al., (Am Rev
with no signs of any shunt. Right heart catherization revieled a normal         Resp Dis 1990;142: 1009-14) that consists of 15 different descriptions of
pulmonary wedge pressure and a pulmonary hypertension responsive to             dyspnea. Interrelations between the verbal descriptions were evaluated by
adenosine infusion. Reumatologic analyses were negative. Bronchoalveolar        means of cluster analysis. We found that patients were able to distinguish
lavage showed 53.3% macrophage, 17.3% eosinophil, 24.3% lymphocyte              different sensations of breathlessness and clinical diagnosis was associated
and 5% neutrophil cell population. Lung volumes measeurments showe:             with unique set of clusters. Descriptions belonging to the cluster work/effort
TLC: 95% predicted; RV: %178 predicted. DLCO/VA was 21% predicted.              were disclosed in all three groups of patients. The verbal range was especially
Cardiopulmonary exercise testing revealed a VO2 of 21% of the predicted         broad in CHF patients, which used all the descriptions and considerably
value. Thoracoscopically obtained lung biopsy showed diffuse vascular wall      narrow in patients with BA. There were some linguistic problems
thickening and plexiform lesions. With all the mentioned findings the           concerning translation of descriptors, especially the cluster “I feel that I am
patient was diagnosed as primary pulmonary hypertension; nasal oxygen           smothering”. In conclusion, the nuances in the ”language of dyspnea” do
therapy, nifedipine and anticoagulation were started.                           have clinical value and verbal description of this symptom have to be an
                                                                                integral part of the clinical approach to the dyspnoeic patients.

110                                                                                                TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002
    TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK                                                             POSTER PRESENTATION

PP-430 (TR)                                                                    endoscopies picture. Involvement of these mechanisms in the
                                                                               development of bronchitis is caused by both influence of an industrial dust
CORRELATION OF HIGH RESOLUTION COMPUTED                                        and by early annexation nonspecific respiratory infection. Thus, the
TOMOGRAPHY FINDINGS AND PULMONARY FUNCTION                                     mechanisms nonspecific infection and allergic (immune) inflammation
TESTS, ARTERIAL BLOOD GAS, DIFFUSING CAPACITY                                  contribute to the development of a bronchitis in dusty industry. The
MEASUREMENTS IN CHRONIC OBSTRUCTIVE                                            prevailing of one of these processes defines clinical variant of disease -
PULMONARY DISEASE                                                              development of chronic obstructive bronchitis with infectional
                                                                               inflammational component and chronic asthmatics bronchitis.
H. Lakadamyal›2, S. Alpar1, H. Ertürk 3, B. Kurt 3
 Atatürk Chest Diseases and Chest Surgery Center, 8th Clinic, Ankara
  Department of Radiology, Medical Faculty of Hacettepe University, Ankara     PP-432
  Department of Radiology, Atatürk Chest Diseases and Thoracic Surgery
  Training and Research Hospital,nkara                                         EVALUTION OF THE LIMITATION OF EXPIRATORY FLOW
                                                                               IN PATIENTS
Chronic obstructive lung disease (COPD) is a major cause of chronic
morbidity and mortality throughout the world. COPD emphasized the              B. Popov, Z. Iankova
terms emphysema and chronic bronchitis. COPD is a disease state                University Hospital of Pulmonary Diseases, Bulgaria
characterized by airflow limitation that is not fully reversible and also
progressive. For the diagnosis and assessment of COPD, pulmonary               We analysed 103 outpatients with COPD for evolution of the expiratory
function tests (PFT), arterial blood gas (ABG) and diffusing capacity (DC)     flow limitation with different risk factors: tobacco smoking >20 p.y.(A).
measurements are corner stones. Currently, high resolution computed            Chemicals and tobacco smoking (B). Tuberculosis and tobacco smoking
tomography (HRCT) has already been used to detect severity, extention of       (C). Nonsmokers with other pulmonary diseases (D). The results of follow-
the paranchimal destruction and anatomic distribution of the disease. In       up in different risk factors with initial and last FEV1 are as follows -Table
this study, the purpose is to analyzed correlation between high resolution     1. The stages of COPD in different risk factors -Table 2. Conclusion: For
computed tomography and lung function tests in diagnosis of COPD.              patients with COPD it is vital to understand the nature of their diseases
Thirty clinically stable patients with chronic pulmonary disease were          and the risk factors for its progression. Optimal management and
exposed to high resolution computed tomography scanning after carrying         treatment should be under dispensary control.
out their PFT, DC and ABG. Twenty five were men and five were women.
The mean age was 63.27 (40-75). Qualitative evaluation based on visual
scoring method in HRCT. Our patients were distinct two major groups            Table 1
(chronic bronchitis (19/30) and emphysema (11/30)). When we compared
all patients without made two main group, there were highly significant        risk factors   no of patients        follow-up       FEV 1-initial   FEV 1-last
negative correlation between indexes of airflow obstruction (FEV1%, L,                                              year            %               %
p<0.001; FEF25-75%, L and PEF%, p<0.005) and COPD stage. In                    A              51                    10.6            54.1            49.8
emphysematous group we found highly significant correlation between            B              8                     8               49.3            47.9
visual score and disease stage (p<0.001), and also we found very strong        C              2                     8               54.5            52.5
correlation between visual score and DLCO (%, L), DLCO/VA (%, L)               D              42                    10              49.7            44.5
measurements (p<0.001). In two patients emphysematous changes were
demonstrated in HRCT without spirometric or other physiological
measurement abnormality. With these values, we conclude at clinical
practice HRCT demonstrate morphological changes in a stage before              Table 2
symptoms develop in emphysematous patients.
                                                                               Stage of COPD       risk factors / no of patients/

                                                                               Mild                A /5/; D /3/
PP-431                                                                         Moderate            A /43/; B /6/; C /2/; D /34/
                                                                               Severe              A /3/; B /2/; D /5/
                                                                               PP-433 (TR)
C. Chonbasheva, T. Sulaimanova2
  Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan                            ANALYSIS OF CLINICAL METHODS USED TO EVALUATE
  RAMS Institute of Occupational Health, Moscow, Russia                        DYSPNEA IN PATIENTS WITH CHRONIC OBSTRUCTIVE
                                                                               PULMONARY DISEASE
In this study 37 patients with chronic bronchitis induced by industrial dust
were examined. Chronic bronchitis was developed under lengthy effect           ‹. Talasl›, M. Erk, S. Cömert
(more than 10 years) of industrial aerosol. The industrial aerosol contained   Department of Chest Diseases, Cerrahpafla Medical Faculty of ‹stanbul
a silica and allergic components (different sensibilysing metals such as       University, ‹stanbul
chrome, nickel, marganese, etc). We found that longacting industrial dust
inhalation causes the development of secondary combined                        Dyspnea - a predominant complaint of patients with COPD- is often
immunodeficiency defining the role in development and progressing of a         considered as the sum of physiologic and psychologic factors that effect a
bronchitis, of infection inflammation, microb sensibilisation, atopical        patient’s functional health status. The aim of this study was to evaluate the
mechanisms caused by development polivalentic sensibilisation to               correlation between clinical methods used to measure dyspnea and
industrial`s allergies components with development of IgE-depend               physiologic measurements in stable COPD patients. A total of 25 patients
inflammation and secondary autoimmunic mechanisms. Our investigation           with COPD were recruited for this cross-sectional study. Entry criteria for
showed the involvement of the main immune inflammatory reactions - I,          the study were: 1) smoking history of more than or equal to 10 pack-years;
II, IY types to the pathogenesis of bronchitis, which contribute to the        2) a history of cough, sputum production and dyspnea not suggestive of

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                                111

asthma; 3) a FEV 1/FVC ratio equal to or less than 0.7; 4) no reversibility;    PP-435
5) being literate. Pulmonary function tests, lung volume measurements,
diffusing capacity, maximum inspiratory and expiratory pressures, mouth         EFFECT OF SALMOTEROL ON QUALITY OF LIFE IN
occlusion pressure, arterial blood gases, six-minute walking test and           PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY
measurement of dyspnea using indirect and direct methods were assessed.         DISEASE AT HIGH-ALTITUDE
The mean values of some parameters were as follows: FEV 1/FVC 56%±11;
RV/TLC 57%±9; PaO2 69±9 mmHg; PaCO2 39±4 mmHg. FVC and                          T. Sooronbaev, M. Mirrakhimov, N. Brimkulov, N. Bakubatova
nearly all methods of dyspnea measurement showed significant                    National Center of Cardiology and Internal Medicine (NCCIM), Bishkek,
correlations. FEV1 showed the only correlation with BDI magnitude of            Kyrgyzstan
effort component (r=0.460). The only dyspnea measurement which
showed correlation with lung volume measurements was BDI magnitude of           The aim of study was to investigate an effect of salmoterol on quality of life
effort component. Maximum expiratory pressure had the only significant,         in patients with chronic obstructive pulmonary disease (COPD), the
but weak correlation with BDI functional impairment component                   permanent residents of high-altitude (2200 m above the sea level). 20
(r=0.453). Nearly all dyspnea measurement methods showed significant            patients with COPD of middle-severe course of the disease at the age of 40-
correlation with 6-minute walking distance. The methods used for                60 years were examined. In all patients study of ventilatory parameters and
measuring dyspnea seem to be valuable tools for following the COPD              analysis of clinical symptoms were conducted. To assess quality of life a
patients as well as their therapy modalities regarding the exercise             brief questionnaire AQ20 (PW Jones, 1994) was used. Salmoterol was
tolerance. Although being rather subjective tools, dyspnea measurement          administered at a dosage of 50 mcg by inhalations twice daily for 12 weeks.
methods are easy to perform and can be used as a complementary                  It was revealed that salmoterol influenced favourably on the course of
examination in the follow-up of COPD patients.                                  COPD. To the end the therapy the ventilatory parameters increased, as
                                                                                values of FEV1 rose up to 79.8±2,6% as compared to the initial value equal
                                                                                to 61.6±3.4% (p≤0.05). At the same time, improvement of life quality in
PP-434 (TR)                                                                     patients with COPD was observed that was manifested in a decrease of
                                                                                scores from 11.8±0.3 to 6.2±0.8 (p≤0.001) by AQ20 questionnaire. Data
OXIDATIVE STRESS, TRACE ELEMENTS AND THEIR                                      obtained showed the efficacy of salmoterol in patients COPD at high-
RELATION TO PULMONARY FUNCTIONS IN CHRONIC                                      altitude.

O. Çilda¤1, F. Karada¤ 1, M. Alt›n›fl›k, D. Kozac› 2, G. Kiter 3, C. Altun3
  Department of Chest Diseases, Medical Faculty of Adnan Menderes               PP-436 (TR)
  University, Ayd›n
  Department of Biochemistry, Medical Faculty of Adnan Menderes University,     SERUM LEPTIN LEVELS IN PATIENTS WITH CHRONIC
  Ayd›n                                                                         OBSTRUCTIVE PULMONARY DISEASE
  Department of Chest Diseases, Medical Faculty of Pamukkale University,
  Denizli                                                                       M. Çal›ko¤lu , G. fiahin2, A. Ünlü 3, B. Ercan 4, L. Tamer 3, A. Kan›k4

                                                                                  Department of Chest Diseases, Medical Faculty of Mersin University, Mersin
The purpose of this study is to investigate the alterations in trace elements     Department of Physical Medicine and Rehabilitation, Medical Faculty of
and oxidative stress and their relation to pulmonary functions in chronic       Mersin University, Mersin
obstructive pulmonary disease (COPD) patients. Twenty-six male,                   Department of Biochemistry, Medical Faculty of Mersin University, Mersin
clinically stable COPD patients (mean age 64±9) and 20 healthy controls
                                                                                  Department of Biostatistics, Medical Faculty of Mersin University, Mersin
(mean age 51±12) were included in the study. The lipid peroxidation
product malondialdehyde was studied spectrophotometrically as a marker
of oxidative stress. Serum concentrations of cupper (Cu) and zinc (Zn)          Leptin is mainly secreted by adipocyte cells and its level tends to increase
were determined by an atomic absorption spectrophotometer. Serum                with human obesity. Although unexplained weight loss may occur in some
concentrations of iron (Fe) was measured by the Ferene assay with               patients with chronic obstructive pulmonary disease (COPD), most of the
ILAbTM 900 autoanalyser. The mean serum malondialdehyde (MDA)                   COPD patients are either normal or overweight. Aim: We aimed to
concentration in COPD patients was found similar to control group               measure sera leptin levels in COPD patients with normal weight. Material
(0.68±0.16 nmol/ml vs 0.62±0.14 nmol/ml, respectively (P=0.167). The            and Method: 26 stable COPD patients and 15 male control participated to
serum concentrations of zinc were significantly lower in patients with          this study. Body mass index (BMI), % ideal body weight (IBW), % fat,
COPD compared to the control group (0.84±0.26 mg/mL vs 1.03±0.25                total skinfold and sera leptin level were measured in all of the participants.
mg/mL; P=0.015), whereas copper concentrations were similar in patient          Leptin levels were measured by ELISA. Results: Patients and control
and control groups (1.06±0.27 mg/mL vs 0.93±0.20 mg/mL; P<0.077).               levels were found to be 24.54±0.60 kg/m2, 24.31 ± 0.45 kg/m2 for BMI;
Cu/Zn ratio was higher in COPD group (P<0.005). There was no statistical        103.57%±2.69, 105.06%±1.90 for IBW, 26.65%±0.88, 27.26%±1.08 for
difference in Fe concentration between COPD patients and control group          fat and 53.69±3.82 cm, 62.00±4.88 cm for total skinfold thickness,
(0.81±0.39 mg/mL vs 0.97±0.45 mg/mL; P=0.239). A positive correlation           respectively (p>0.05). Sera leptin levels were also not significantly
was detected between FEV1 and Zn (r=0.324, P=0.050). When the                   different between patients and controls (2.15±0.22 ng/ml, 2.90±0.31
patients were classified according to ATS criteria, serum Zn concentration      ng/ml 3, p>0.05). Discussion: Although leptin levels were lower in
was lower in severe (grade III, FEV 1<35%) COPD than grade I-II patients        patients group, this difference was not statistically different. Our studies
(P=0.035). In conclusion, there was no significant difference in serum          suggest that leptin regulation remains normal in patients with normal
concentrations of Cu, Fe and MDA in stable COPD patients and healthy            weight. Measuring leptin levels may be more usefull when compared in
control subjects whereas serum Zn concentration was lower and Cu/Zn             patients with and without weight loss.
ratio was higher. It is concluded that serum Zn concentration may be used
as a marker of severity of COPD because of its correlation with FEV1.

112                                                                                                TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002
 TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK                                                            POSTER PRESENTATION

PP-437                                                                           PP-439

DISEASE AND RESPIRATORY INSUFFICIENCY                                            BRONCHITIS

N. Davletalieva, T. Sooronbayev, M. Mirrakhimov                                  Z. Mazhitova, R. Seysebayeva
National Centre of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan         The Kazakh National Medical University, Kazakhstan

Respiratory insufficiency during exacerbations of chronic obstructive            For early revealing of pulmonary ventilation impairments the state of
pulmonary disease (COPD) is a leading syndrome and requires compulsory           external breathing function in 161 children at the age of 5 to 16 years,
correction. In order to evaluate the effectiveness of long – term oxygen         permanently residing in the zone of ecological catastrophe of the Aral Sea
therapy in patients with respiratory insufficiency during exacerbations of       region was studied. The study was carried out on automatic computer
COPD we examined 8 patients before and after treatment. Oxygen therapy           spirograph “SPIROSIFT-5000” (Japan). The state of bronchial passing was
was carried out using an oxygen concentrator (Permox Silent Care, Drager         determined with the help of peakflowmetry, the indices of peak rate of
firm, Germany). Oxygen therapy was carried out at a rate of 2 L/min for 15       expiration was compared with normative values, calculated with taking in
hours per day throughout the entire stay of the patient in hospital (14          to account the length of the body, sex and age. For determining of
days). Clinical data and respiratory function were studied using a body          bronchial obstruction recurrence the test with berodual allowing to assess
plethysmograph (Master Lab Pro, Erich Jaeger firm, Germany). The                 objectively the adrenergic and cholenergic components was performed. As
electrolyte and gas composition of blood and oxygen saturation                   a result of the investigations of the impairments of expiration function was
(Instrumentation Laboratory of the firm IL- 1650, Italy) were determined.        found out in 70.8% of children. Obstructive type of pulmonary ventilation
Good individual tolerance of oxygen therapy and a significant                    impairment was revealed in 52.7% of patients, restrictive one - in 15.5%
improvement in the state of all the patients were noted after treatment. In      and mixed one – in 2.6% of examined patients. Thus in most of the cases
addition to the improvement in ventilatory parameters, an increase in            in children permanently residing in crisis zone of the Aral Sea region the
oxygen saturation from 76.6±6.9% to 89.6 ± 2.5%, p<0.05 was found.               impairments are of obstructive character with moderate considerable
Thus, long – term oxygen therapy combined with antibacterial and                 degree of evidence.
bronchodilator therapy in patients with respiratory insufficiency during
exacerbations of COPD can be effective and expedient throughout the
entire stay of the patient in hospital.                                          PP-440

                                                                                 PATHOGENIC MECHANISMS OF OBSTRUCTIVE
PP-438                                                                           PULMONARY SYNDROME

CYTOLOGICAL DESCRIPTION OF THE BRONCHIAL TREE                                    O. Kotsarev1, S. Antonyuk1, V. Polytaeva2
AMONG CHILDREN OF THE ARAL SEA REGION WITH                                         Dniepropetrovsk Municipal Clinical Hospital 4, Ukraine
CHRONIC BRONCHITIS                                                               2
                                                                                   Dniepropetrovsk National University, Ukraine

Z. Mazhitova, R. Seysebayeva                                                     On modern representations the hyperreactivity of respiratory pathes roots
The Kazakh National Medical University, Kazakhstan                               the obstructive pulmonary syndrome. However it is impossible to estimate
                                                                                 convincingly the basic exhibitings of this syndrome from these positions:
The goal of the given investigation is the studying of the cytological           expiratory character of dyspnea, distelectases and atelectases, acute
description of the bronchial tree among children of the Aral Sea region          emphysema, expiratory closure of bronchioles and the smaller bronchus’s,
with chronic bronchitis. 161 children at the age from 5 to 15 years were         which are connected with a respiratory department of the lungs. The
examined. The cytological study of the impression smear from mucous              purpose of examination: to find out a role of adaptive mechanisms of a
membrane of the bronchial tree was carried out. In 48.5% of children with        respiratory department of lungs, surfactant system in a pathogenesis of
catarhal endobronchitis the cytogram was characterised by the presence of        obstructive pulmonary syndrome in particular. Materials and Methods:
cylindrical epithelium cells with the signs of inflammatory dystrophic           lungs of patients died from bronchial asthma and lungs of rats with
degenerations and distinctly marked proliferation. On the background of          proserinal and obsidanal models of obstructive syndrome were studied by
reactive proliferative degenerations the cells typical for dysplasia of light    means of the morphological, biochemical and physicochemical methods.
degree (D-1) were found out in 35.3% of children with catarhal-purulent          Results: in fields of an emphysema at the bronchial asthma the quantity
endobronchitis. On the background of inflammatory- proliferative process         of phospholipids was reliably increased, their surface activity raised. The
there were determined cells, typical for dysplasia of moderate degree (D-2)      similar legitimacies were noticed in experiment. Conclusions: as the
in 16.2% of children with purulent endobronchitis. In 2 children with            expiration is provided with forces of interfacial tension on 70-80%
purulent endobronchitis there were cells of cylindric epitelium with the         (P=2ã/R-Laplace law), so the excess of phosphotides on the border
signs of marked degree of dysplasia (D-3). Thus, in children-permanent           hypophase-air reduces sharply these forces, that causes expiratory character
residents of the crisis zone of the Aral Sea region the deep impairments of      of a dyspnea, development of an acute emphysema. The same mechanism
mucous membrane of bronchial tree are formed early. Cytological                  rooted the expiratory closure of bronchioles and smaller bronchuses, so it
investigations revealed the impairment of differentiating of bronchus            causes the development of acute respiratory failure. The conceptual and
epithelial layer cell elements, that is testified by the presence of different   physical models of obstructive pulmonary syndrome were offered,
degrees of dysplasia.                                                            including pathogenic mechanisms both of the conductive and the
                                                                                 respiratory departments of lungs, the surfactant system in particular. The
                                                                                 offered models allow to convince and reliably explain all the known
                                                                                 exhibitings of this pathology.

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                            113

PP-441 (TR)                                                                      observed in BMI, PIW levels between the different stages of COPD.
                                                                                 According to NI levels; PO2,FEV1,VC were observed to be significantly
THE CAUSATIVE PATHOGENS OF COPD EXACERBATIONS                                    higher in cases with NI>0.5 (p>0.05). We determined that respiratory
IN THE MID BLACK SEA REGION                                                      functions were closely related to nutritional parameters in COPD cases.

D. Katar 1, M. Erkan 1, A. Saniç2, A. At›c›2
 Department of Chest Diseases and Tuberculosis, Medical Faculty of Ondokuz       PP-443 (TR)
  May›s University, Samsun
  Department of Microbiology, Medical Faculty of Ondokuz May›s University,       COMPARATIVE STUDY OF THE RESULTS OF EARLY
  Samsun                                                                         REVERSIBILITY WITH SALBUTAMOL AND IPRATROPIUM
The aim of this study was to investigate the causative pathogens and their
sensitivity to antibiotics in COPD patients with exacerbations. The patients     G. Yüce, Z. Ketenci, G. Yurteri, D. Marafll›, S. Saraç, Ö. Demiröz
(40 male and 3 female) with Anthonisen Type-1 exacerbation had visited to        Heybeliada Chest Diseases and Thoracic Surgery Training and Research
our department between December, 1999 and December, 2001. The mean               Hospital, ‹stanbul
FEV1 value of patients was 748+418 ml (28.5% predicted). Complete blood
counts, blood chemistry, spirometric tests and chest x-rays were evaluated.      In chronic obstructive pulmonary disease (COPD) where airway
During admission, the sputum samples of the patients were taken for Gram’s       obstruction is partially reversible, reversibility test is used to measure the
stain and culture. In addition, serologic tests were performed on day 0 and      effectiveness of corticosteroid treatment and to estimate diagnosis. In our
21. The microbiologic culture of sputum yielded several pathogens in 41.9%       study we aimed to make comparison between the effects of bronchodilator
of patients (18/43). H. influenzae was the most common bacterium which           agents salbutamol and ipratropium bromide in predicting the early
was seen in 30.2% of patients (13/43). Other bacteria were S. pneumoniae     ,   reversibility in stable COPD patients. 50 cases (7 female, 43 male)
                ,          ,                              .
K. pneumoniae K. oxtoca S. marcescensand AcinetobacterEach of them was           diagnosed as COPD according to ATS criterions were included in the
seen in one patient. The results of antibiograms showed that penicillin,         study and were randomly classified into 3 groups. Reversibility test was
ampicillin and amoxicillin resistance for H. influenzae were respectively        done in the first group with salbutamol, in the second group with
53.8%, 53.8%, 38.5%. No resistance was proven for antibiotics which              ipratropium bromide and with placebo in the third group. Cases with an
contain inhibitors of β-lactamase, erythromycin, ciprofloxacin and               increase of absolute value, 200 ml, were accepted as reversible. As a result
cefepime. The resistances of penicillin (61.1%), ampicillin (61.1%) and          no significant difference was found istatistically between the early
amoxicillin (50%) were the highest in all study group; while the resistances     bronchodilator effect of salbutamol and ipratropium bromide (p>0.005).
of ciprofloxacin (5.6%), cefepim (5.6%) and piperacilin/tazobactam had           But when compared with placebo we found a significant difference for
showed low resistance (5.6%). Serologically, acute C. pneumoniae was             both of the drugs (p<0.05). Considering these we come to the conclusion
identified in 30.2% of patients (13/43). The specific IgM was positive in only   that in reversibility prediction of stable COPD patients salbutamol and
one patient. In addition, the antibody titer of one patient was over 1: 512.     ipratropium bromide can be used equivally.
Acute M. pneumoniaeinfection was detected in 16.3% of patients (7/43).
Only one patient in this group had a positive specific IgM. Polimicrobial
exacerbation was also identified in 23.3% of patients (10/43). The dominant      PP-444 (TR)
bacteria which cause acute exacerbation of COPD in our hospital were H.
influenzaeand C. pneumoniae Due to the common resistance to penicillin
                               .                                                 SERUM IMMUNOGLOBULIN LEVELS IN COPD CASES AND
among our patients, we suggest that prescribing antibiotics with broad           ASYMPTOMATIC SMOKERS
spectrum inhibitor of β-lactamase, macrolid and quinolones would be the
most appropriate approach.                                                       F. Deveci1, T. Turgut 1, H. Akbulut2, G. K›rk›l2, M. Muz 2
                                                                                   Department of Chest Diseases, Medical Faculty of F›rat University, Elaz›¤
                                                                                   Department of Immunology, Medical Faculty of F›rat University, Elaz›¤
PP-442 (TR)
                                                                                 Introduction: Bronchial infections often occur in smokers and it seems to
NUTRITIONAL STATUS AND LUNG FUNCTION IN                                          be related with the presence of chronic bronchitis. The relation between
PATIENTS WITH COPD                                                               recurrent exacerbations in COPD and serum immunoglobulin (Ig) changes
                                                                                 depend on smoking is unknown. Aim: We aimed to investigate the
M. Bal›o¤lu, B. Kömürcüo¤lu, E. Çelikten, S. Akto¤u, C. Biçmen                   relation between recurrent pulmonary infections in current smoker COPD
‹zmir Dr. Suat Seren Chest Diseases and Thoracic Surgery, Training and           cases and IgG and subclasses. Material and Methods: The study is
Research Hospital, ‹zmir                                                         performed in the Department of Chest Diseases, Medical Faculty of F›rat
                                                                                 University prospectively. Three groups were included in the study; current
To investigate the relationship between nutritional status and lung              smoker COPD cases (n=30), asymptomatic smokers (n=15) and never
function, 75 hospitalized COPD patients were evaluated. Anthropometric           smokers (n=15). Serum IgG, IgA, IgM and IgG subclasses were assessed in
measurements (percent ideal body weight (PIW), body mass index (BMI),            cases who have inclusion criteria. Results: Serum IgG levels were
triceps skin fold thickness (TSF), arm muscle circumference (AMC)),              significantly lower in both COPD cases and asymptomatic smokers than
respiratory function parameters (FEV1, FVC, VC, FEV1/FVC, pH, PCO 2,             never smokers (respectively; p=0.001, p<0.002). Similarly IgG2 level was
pO2) and nutritional parameters (serum prealbumin, transferrin, albumin,         significantly lower in both COPD cases and asymptomatic smokers than
total lymphocyte count (TLC) were worked out and nutritional index               never smokers (p<0.001). Moreover when COPD cases were divided in
(NI) was calculated. Between the groups of cases with emphysema and              two groups depend on number of exacerbations (number of exacerbations
chronic bronchitis PIW, BMI, prealbumin levels were found to be                  4 and >4 in recent 2 years) there was no difference between IgG and IgG2
significantly different (Mann Whitney U test, p>0.01). According to their        levels. Conclusion: We observed that smoking reduced serum IgG and
FEV1 levels, the cases were classified as mild, moderate and severe COPD         IgG2 levels but there was no relation between number of exacerbations in
(stageI-II-III COPD), using ATS classification. A significant difference         in COPD cases and these levels.
was found in albumin, transferrin, prealbumin, TLC, TSF, and AMC levels
between mild and heavy COPD groups (p>0.01).There was no difference

114                                                                                                 TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002
 TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK                                                              POSTER PRESENTATION

PP-445 (TR)                                                                      PP-447 (TR)

ACUTE EXACERBATION                                                               PULMONARY DISEASE IN WOMEN
                                                                                 A. Yak›flan, A. Çilli, O. Özbudak, T. Özdemir, C. O¤us
P. Ergün 1, Ü. Y›lmaz Turay 1, M. Aydo¤du1, Y. Erdo¤an1, Ç. Biber 1,
                                                                                 Department of Chest Diseases, Medical Faculty of Akdeniz University, Antalya
fi. Alt›ndirek A. Ça¤lar 2
  Atatürk Chest Diseases and Thoracic Surgery Center, Ankara                     To investigate risk factors for chronic obstructive pulmonary disease (COPD)
  Hacettepe University, Ankara                                                   in women, 48 female patients with COPD were followed up in our hospital.
                                                                                 Forty-seven female non-COPD subjects were included as control group. Age,
The aim of this study is to evaluate the nutritional status of COPD patients
                                                                                 occupation, place of residence, history of chronic bronchitis, comorbid
with acute exacerbation and possible relationship between nutritional
                                                                                 conditions, cigarette smoking (active and passive), occupational exposure,
parameters with pulmonary functions. 53 patients were divided into two
                                                                                 socioeconomical conditions, air pollution, education, passive smoking in
groups as severe (FEV1<50 %) and mild to moderate (FEV1 50 %) COPD to
                                                                                 childhood, the fuel used for heat, food and domestic wood smoke, and its
compare study parameters. IBW % was 104.42±26.21 in severe COPD
                                                                                 duration were questioned, and pulmonary function tests were done. Results
where as it was 115.31±24.17 in mild to moderate COPD. Mean values of
                                                                                 from this study suggest that exposure to cooking smoke, education, age, place
serum albumin, transferrin were in normal range. Delayed cutaneous
                                                                                 of residence were associated factors with COPD among women.
hypersensitivity skin test revealed normal immunologic status. When the
study parameters were compared between severe and mild to moderate
                                                                                 PP-448 (TR)
COPD groups no statistically significant differences were detected in
nutritional parameters. No correlation was found between IBW % and
                                                                                 NEBULISED MAGNESIUM SULPHATE IN EXACERBATIONS
pulmonary function tests, arterial blood gases. Though a positive correlation
                                                                                 OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
was found between IBW % and DLCO (r=0.353, p=0.035). For the total
study group there was no significant difference between the actual weight        E. Toprak, A. Çilli, A. Yak›flan, T. Özdemir, C. Ö¤üfl, O. Özbudak
and the ideal body weight. However, the actual weight versus the usual           Akdeniz University Hospital Respiratory Medicine, Antalya
weight was highly significant (p<0.001). As a conclusion patients with
emphysema may prone to nutritional depletion. Monitoring of nutritional          Acute exacerbations of chronic obstructive pulmonary disease (COPD) are
parameters and eventual dietetic treatment should also be included in the        commonly treated with bronchodilators such as ipratropium bromide (IB),
goals of the medical treatment in acute exacerbation of COPD.                    salbutamol, corticosteroids, antibiotics, and supplemental oxygen.
                                                                                 Magnesium sulfate (MgSO4) is sometimes used in bronchial astma as an
                                                                                 alternative therapy. In this study we examined the effects of nebulised
PP-446 (TR)                                                                      MgSO4 in patients with acute exacerbations of COPD. Patients who apply
                                                                                 to Akdeniz University Hospital were randomized in a double blind fashion.
PERCEPTION OF BRONCHOCONSTRICTION IN PATIENTS                                    They were separated three groups, and all patients were received nebulised
WITH OBSTRUCTIVE PULMONARY DISEASES                                              salbutamol as an initial therapy. After that, patients were allocated randomly
A. Ekici1, S. Y›lmaz1, Y. Karadeniz1, Ö. O¤uztürk 1, T. Kara 1, A. ‹te¤inli ,
                                                                          1      to receive one of these three medications; MgSO4, IB, ad placebo. Patients
M. Arslan1, E. Kurtipek1, S. Demir2, Z. Apayd›n2                                 were observed for 4 hours to document the effect on FEV1 values, oxygen
  K›r›kkale University, K›r›kkale                                                saturation, dyspnea score, heart rate, respiratory rate, and blood pressure.
  K›r›kkale State Hospital, K›r›kkale                                            Thirty one individuals were studied (11 were in MgSO4 group, 10 were in IB
                                                                                 group, and 10 were in placebo group), two patients discountinued the study
Objective: We investigated whether perception of dyspnea in patients with        (1 in MgSO4 group and 1 in placebo group). Baseline charactheristics and
bronchiectasis is different from with asthmatics or with chronic bronchitis.     baseline FEV1 values were similar in all groups. While the mean increase in
Moreover, the contribution of clinical variables to changes in dyspnea was       FEV1 values between MgSO4 and placebo group was not different (-
assessed. Material and Methods: We studied 103 consecutive patients, 42          0.02L±0.06L, and 0.02L±0.11L, respectively), it was significantly higher in
with bronchiectasia, 35 with asthma and 26 with chronic bronchisitis (CB)        IB group (0.09L±0.02L) (p=0.018). This superior effect was lasted 40
in similar ages. Patients with bronchiectasis were grouped as patients with CT   minutes and after that, the degree of increase in FEV1 is similar in all groups.
evidence of emphysema (CTE) and no CT evidence of emphysema (NCTE).              In conclusion, nebulised MgSO4 is not as efficacious as IB when adding
Histamine inhalation test was performed on patients to determine the level       salbutamol in the treatment of acute exacerbations of COPD.
of bronchial hyperreactivity. During the histamine test, intensity of
breathlessness was estimated before each FEV1 measurement with a modified
Borg scale. The Borg score in FEV1 reduction by 20% was determined as            PP-449 (TR)
perception score 20 (PS20). Results: Mean PS20 values of patients with CTE
(0.98±0.23). and CB (1.14±0.25) was significantly lower than patients with       COMPARISON OF INHALER AND NEBULISER
NCTE (2.02±0.28) and asthma (2.00±0.20) (p<0.05).The ratio of non-               BRONCHODILATOR TREATMENTS IN COPD ATTACKS
perceivers in patients with CTE (45.0%) and in patients with chronic             A. Mirici, M. Meral, M. Akgün, S. Kirifl, N. Y›lmaz
bronchitis (38.5%) was significantly higher than patients with NCTE (9.1%)       Department of Chest Diseases, Medical Faculty of Atatürk University, Erzurum
and asthma (8.6%) (P<0.05). No significant correlation was found between
PS20 and baseline FEV1 values of patients in all groups; with NCTE (r= -         The purpose of the study was to compare the inhaler and nebuliser
0.288, p=0. 194), CTE (r=-150, p=0.527), asthma (r=0. 028, p=0. 871) or CB       bronchodilator treatments in COPD attacks from the point of effectiveness,
(r=0.196, p=0. 337). Conclusions: Perception of bronchonstriction in             cost and side effects. The results of initial PEF and arterial blood gas analysis
patients with CT evidence of emphysema and in patients with chronic              of 41 patients admitted and required hospitalization, with attack moderate to
bronchitis was lower than in patients with no CT evidence of emphysema           severe were recorded. Bronchodilator treatments were given 20 patients as
and asthmatics, in similar age group. In addition, the ratio of non-perceivers   inhaler (I) form, salbutamol (S) and ipratropium bromide (IB) combination
in patients with CT evidence of emphysema and patients with chronic              4x4 puf/day (100 mg S and 20 m g IB in a puff), and 21 patients as nebuliser
bronchitis were higher than the other groups. Perceptual features were           (N) form, S and IB combination 4x1 nebuliser solution/day (3 mg S and 0.5
unrelated to the baseline pulmonary functions in all groups.                     mg IB in an inhalation solution), according to their administration days. In
                                                                                 I group, 8 patients were excluded from the study because of their discordance

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                                 115

to treatment. Baseline age, sex and PEF values were similar between the             were similar in both groups (p>0.05). Though not statistically significant,
groups. The results of treatment were evaluated by repeating the                    spirometric recovery of Group I was found higher than Group II. While in
measurements on the 30th min, 6th, 24th, and 48th hours and 10th day and            Group A pH and BUN levels were lower and P(A-a)O2 was higher than
the changes according to baseline values. Statistical analysis was performed        Group B (p<0.05), demographic, clinical and other laboratory parameters
through variance analysis and Mann-Whitney U test. As a results PEF% and            were similar in both groups (p>0.05). Mechanical ventilation was used in
PaO2% increases on the 10th day in N group (increases in PEF % were 44%             4 patients in Group A and 2 of them died (p<0.05). In conclusion, we
and 54% and in PaO2% were 28% and 54% in I and N groups respectively),              think that hypercapnia may be reversible in patients admitted with
and PaCO2% change in I group in all time periods were found to be better            hypercapneic acute COPD attack when SaO2 and BUN levels are high
but the differences were not significant statistically. Though they were            and P(A-a)O 2 levels are low, and patients with PaCO2 levels higher than
similar from the point of effectiveness, I treatment was 4 times as cheap as        60 mmHg may benefit much from medical treatment.
that of N treatment (6$ versus 24$). The costs of the nebulisation systems
were not calculated. Although these results had equal effectiveness, I              PP-452 (TR)
treatment had lower treatment cost and lower personnel requirement. So, we
believe that it has more advantages.                                                SUPPLEMENTAL OXYGEN AND HYPERCAPNIA IN THE
                                                                                    ACUTE ATTACK THERAPY OF CHRONIC OBSTRUCTIVE
PP-450                                                                              PULMONARY DISEASE

ROLE OF METABOLIC DISTURBANCES IN PATIENTS WITH                                     Ö. K›zk›n, H. Günen, S. Hac›evliyagil
BRONCHIAL OBSTRUCTION                                                               Department of Chest Diseases, Medical Faculty of ‹nönü University, Malatya
                                                                                    The aim of this study was to investigate the effect of 2 L/min oxygen
L. Shailieva, M. Petrova, M. Zorina, N. Pavljukova
                                                                                    administered with a nasal catheter on hypoxemia and development of
Hospital Therapeutic Department, St. Petersburg State Medical University,
                                                                                    hypercapnia in chronic obstructive pulmonary disease patients with acute
                                                                                    attack (COPD-AA). Type I (PaO2<55 mmHg, Group I, n=26) and Type II
We studied 67 patients (age from 19 to 72 years) with respiratory oxalosis          (PaCO2>45mmHg, Group II, n=36) respiratory failure patients who had
(RO), 20 healthy controls without RO symptoms and 23 practically healthy            been referred to the emergency service with COPD-AA have been included
persons. Oxalates’ levels in a liquid of bronchoalveolar lavage were evaluated      in the study. The patients’ clinical and laboratory findings and the arterial
by a infra-redspecroscopy method, in daily urine by Sivorinovsky method,            blood gas (ABG) results while breathing room air and 2L/min supplemental
condensate of exhaled air (CEA). We found the oxalates in lavage                    oxygen with a nasal catheter in addition to optimal therapy were recorded.
(2.02±0.04 mmol/l) and daily urine (0.32±0.03mmol/l), CEA -                         The mean age, duration of disease and smoking habits in Group I and II
(4.7±0.05mcmol/l) in patients with hyperoxaluria as well as direct                  patients were similar (p>0.05). In laboratory parameters; PaO2, pH
dependence of obstruction severity from the oxalate level in lavage and daily       (p<0.001) and FEV1 (p>0.05) were lower in Group II. While breathing room
urine; in patients without RO - in lavage (0.25±0.02 mmol/l), in condensate         air and supplemental oxygen PaO2 values in Group I patients were 48.8±4.8
- (3.7±0.06 mmol/l) and in urine - (0.16±0.03 mmol/l); in healthy persons -         mmHg and 55.4±7.5 mmHg respectively (p<0.001). However PaO2
in condensate (2.6±0.07 mcmol/l) and in urine - (0.10 ±0.04 mmol/l). In             remained under 60 mmHg in 23 patients (88.5%), and PaCO2 increased
patients with RO in comparison with patients with allergic asthma were:             more than 10 mmHg in one patient. In Group II patients, the PaO2value
more favorable of bronchoobstruction, without positive effect from basic            increased from 39.6±12.1 mmHg to 56.6±19.1 mmHg (p<0.001), and
asthma treatment; moderate or latent obstructive disorders during lung              PaCO2 decreased from 61.6±12.4 mmHg to 58.1±15.6 mmHg (p>0.05).
function tests; softly expressed allergic symptoms - low eosinophilic content       While PaO2 remained under 60 mmHg in 26 patients (77.2%), PaCO2
in peripheral blood, bronchial lavage without features of inflammation; a low       increased more than 10 mmHg in 6 patients with the oxygen treatment
level of IgA, negative or poorly positive skin allergic tests; cholelithiasis and   (16.7%). In those cases whose PaCO2 increased (Group III, n=7), the
- or diskinesia of the biliary tracts; hyperoxaluria and/or urolithiasis;           disease duration, PAP values and smoking habits were found to be higher
osteochondrosis; white colour of skin, back pigmentation. We treated this           (p<0.05, p>0.05, p>0.05), and initial FEV1 value was found to be lower
patients with a diet (without oxalate metabolites), vitamins of group B,            (p>0.05). In conclusion, it was found in this study that administration of
preparations of magnesium intravenously.                                            2L/min oxygen with a nasal catheter may not be sufficient improving
                                                                                    hypoxemia in majority of COPD-AA patients, and the oxygen therapy
PP-451 (TR)                                                                         mentioned raises PaCO2 further in 15-20% of hypercapneic patients.

REVERSIBLE HYPERCAPNIA IN ACUTE ATTACK OF                                           PP-453 (TR)
                                                                                    THE EVALUATION OF QUALITY OF LIFE IN CHRONIC
Ö. K›zk›n1, H. Günen 1, S. Hac›evliyagil, S. Yolo¤lu2
                                                                                    OBSTRUCTIVE PULMONARY DISEASE BY USING
  Department of Chest Diseases, Medical Faculty of ‹nönü University, Malatya
                                                                                    ST. GEORGE’S RESPIRATORY QUESTIONNAIRE (SGRQ)
  Department of Biostatistics, Medical Faculty of ‹nönü University, Malatya
                                                                                    T. Tatl›c›o¤lu, N. Köktürk, D. Ye¤in, M. Habeflo¤lu, M. Yüceege
Hypercapnia is frequently encountered during acute attacks of chronic
                                                                                    Department of Chest Diseases, Medical Faculty of Gazi University, Ankara
obstructive pulmonary disease (COPD), and is reversible in some cases.
This study was designed to investigate the clinical and laboratory features         In this study, quality of life measurement by using the St. George’s
affecting the reversibility of PaCO2 in COPD patients with hypercapneic             Respiratory Questionnaire (SGRQ) that is specific to chronic obstructive
acute attack. Among 40 patients with hypercapneic acute COPD attack,                pulmonary disease (COPD) and the correlation of this questionnaire with
the ones whose PaCO2 decreased 15% or more with medical treatment                   physiological parameters were examined. For this purpose, 83 stable COPD
were classified as Group I (n=16), the other patients were classified as            patients were evaluated. 15.5 % of patients were female and 84.3 % were
Group II (n=24). Another classification for the same patients was done as           male with the total mean ages of 66±9 (41-82). Their mean
Group A (PaCO2 60 mmHg, n=17) and Group B (PaCO2<60 mmHg,                           prebronchodilator values of 1st second forced expiratory volume (FEV1 %
n=23). While in Group I oxygen saturation (SaO2) and BUN level were                 of predicted) were 41.61±14.44 (14-73). Symptom, activity, impact and
higher and alveolo-arterial oxygen gradient P(A-a)O2 was lower than                 total scores were calculated using the SGRQ. The correlations of symptom
Group II (p<0.05), demographic, clinic and other laboratory parameters              scores with activity scores and impact scores were weak but statistically

116                                                                                                    TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002
 TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK                                                             POSTER PRESENTATION

significant (r=0.27, r=0.31, p<0.05). The correlation of activity scores         titative ventilation-perfusion (V/Q) scintigraphic studies in 17 male
with impact scores (r=0.52, p<0.01) was statistically significant. The           patients (mean age 65.6±5.5 years) with chronic obstructive pulmonary
correlations of FEV 1% of predicted, partial oxygen pressure (PO2), partial      disease (COPD). The mean forced vital capacity (FVC) value of the
carbondioxide pressure (PCO2) with all scores were not statistically             patient group was 2352±642 mL (65.4%±15.8), whereas mean forced expi-
significant (p>0.05). When the patients were classified as having moderate       ratory volume in one second (FEV1) was found to be 1150±442 mL
and severe COPD according to Gold criteria, the correlations of FEV1% of         (40.8%±14.9). The ratio of carbon monoxide diffusion to alveolar ventila-
predicted with all scores including total scores were not statistically          tion (DLCO/VA) was 3.17±0.88 mL/min/mmHg/L, and the mean partial
significant (p>0.05). The correlations of the duration of disease with           oxygen (PaO2) and carbon dioxide (PaCO2) pressures were 68.5±11.04
activity scores, impact scores and total scores were statistically significant   mmHg and 38.9±5.8 mmHg respectively. For each patient, thorax HRCT
(r=0.26, r=0.31, r=0.32, p<0.05). As a result it is concluded that               and V/Q scintigraphic images of both lungs were divided into upper, mid
physiological parameters may not reflect the quality of life measurements.       and lower zones during examination. Visual scoring for the assessment of
                                                                                 emphysema on thorax HRCT were used and images were graded from 1 to
PP-454 (TR)                                                                      4. Emphysema scores were found to be higher on upper zones with accom-
                                                                                 panying lowest V/Q ratios. DLCO/VA, total emphysema scores, and indi-
THE EFFECTS OF ANTIOXIDANT THERAPY ON LUNG                                       vidual emphysema scores of the upper, mid and lower zones were found to
CLEARANCE, PULMONARY FUNCTION TEST AND                                           be correlated. In upper and middle zones no correlation was detected
OXIDANT STRESS IN PATIENTS WITH COPD                                             between emphysema scores and V/Q scintigraphy. Lowest V/Q ratios were
                                                                                 noted in the upper zones of each lung (V/Q: 0.8) As a conclusion, it can
H. Demirel1, T. Demir 1, N. Y›ld›r›m1, O. Özmen 2, B. Kanmaz 2, H. Uzun 3,       be stated that emphysematous changes in COPD patients are more appar-
E. Uslu 3                                                                        ent in the upper lung zones, which also have the lowest V/Q ratios.
  Department of Chest Diseases, Cerrahpafla Medical Faculty of ‹stanbul
  University, ‹stanbul                                                           PP-456 (TR)
  Department of Nuclear Medicine, Cerrahpafla Medical Faculty of ‹stanbul
  University, ‹stanbul                                                           INSPIRATORY FLOW RATES IN CHRONIC OBSTRUCTIVE
  Department of Biochemistry, Cerrahpafla Medical Faculty of ‹stanbul             PULMONARY DISEASE
  University, ‹stanbul
                                                                                 T. Demir, H. Demirel, N. Y›ld›r›m
The effects of a 6-week course of antioxidant therapy on the lung                Department of Chest Diseases, Cerrahpafla Medical Faculty of ‹stanbul
clearance, pulmonary function tests (PFT), arterial blood gases (ABG),           University, ‹stanbul
malonyledialdehyde (MDA), superoxide dismutase (SOD), vitamin C and
                                                                                 The characteristics of inspiratory flow rates of 43 male patients with chron-
vitamin E values of 13 male COPD patients were evaluated. The
                                                                                 ic obstructive pulmonary disease (COPD) were evaluated. The mean age of
characteristics of the study population were as follows: The mean age was
                                                                                 the patient group was 64.9±8.2 years and the mean total amount of ciga-
66.23±6.99 years; mean disease duration was 11.8±7.4 years and mean
                                                                                 rettes smoked was 57.8±39.1 pack/years. The mean pulmonary function test
amount of cigarettes smoked was 50.7±23.9 pack/years. The initial FEV1
                                                                                 result were as follows: forced vital capacity (FVC) 2538±789 mL
value was 1250±659 mL (%44.9±16) and the initial DLCO/VA value was
                                                                                 (70.3%±16.7), forced expiratory volume in one second (FEV1) 1242±506
3.2±1.2 mL/min/mmHg/L (%63.8±24.5). No significant changes were
                                                                                 mL (44.7%±13.9), forced inspiratory vital capacity (FIVC) 2430±755 mL,
observed in the PFT and ABG after therapy. Although a slight decrease
                                                                                 partial pressure of oxygen (PaO2) 69.2±11.3 mmHg, partial pressure of car-
was noted in lung clearance with antioxidant therapy, the difference did
                                                                                 bon dioxide (PaCO2) 39.4±5.5 mmHg and oxygen saturation (SatO2)
not reach statistical significance (p<0.05) (right clearance: 138.46±77.63
                                                                                 93.2%±3.9. The inspiratory flow rates were evaluated and forced inspiratory
min before and 118.38±83.19 min after therapy; left clearance: 140±91.99
                                                                                 volume in one second (FIV1), forced inspiratory flow (FIF) 50%, FIF 25%,
min before and133.92±85 min after therapy). The MDA levels decreased
                                                                                 and FIF 75% were found to be 1937±621 mL, 2.85±1.2 L/sec, 1.17±0.18
from 7.66±0.85 nmol/mL to 6.11±0.29 nmol/mL whereas SOT levels
                                                                                 L/sec, and 1.0±0.15 L/sec respectively. The expiratory flow rates on the other
increased from 20.44±2.4 U/mL to 23.7±2.7 U/mL with therapy (p<0.05).
                                                                                 hand were detected to be as follows: forced expiratory flow rate (FEF) 50%,
Significant increases were observed in mean Vitamin E and C levels
                                                                                 FEF 25% and FEF 75% were 0.62±0.09 L/sec, 1.09±0.1 L/sec and 0.14±0.02
(p<0.05). (vitamin E: 0.7±6.2 %mg before and 0.82±7.2 %mg after
                                                                                 L/sec respectively. All of the inspiratory flow rates were higher compared to
therapy; vitamin C: 4.31±0.22 mg/dL before and 5.09±0.44 mg/dL after
                                                                                 the expiratory flow rates (p<0.001). This finding can indicate that inspira-
therapy) Our findings indicate that antioxidant therapy as an adjunct to
                                                                                 tory flow rates are generally preserved in cases with COPD.
diet is effective on oxidant-antioxidant balance but has no demonstrable
effects on pulmonary function tests and lung clearance.
                                                                                 PP-457 (TR)
PP-455 (TR)
                                                                                 THE EFFECT OF NEBULIZED BRONCHODILATORS ON
PERFUSION SCINTIGRAPHY IN COPD                                                   Ü. fiahin1, E. Mensiz 2, A. Üzüm Kaya 2, M. Öztürk 3, A. Akkaya3
                                                                                   Department of Chest Diseases, Medical Faculty of Süleyman Demirel
S. Akp›nar, T. Demir 1, H. Demirel1, B. Mutlu 1, N. Y›ld›r›m1, C. Akman2,          University, Isparta
O. Özmen3                                                                        2
                                                                                   Department of Ophthalmology, Medical Faculty of Süleyman Demirel
  Department of Chest Diseases, Cerrahpafla Medical Faculty of ‹stanbul             University, Isparta
  University, ‹stanbul                                                           3
                                                                                   Department of Public Health, Medical Faculty of Süleyman Demirel
  Department of Radiology Cerrahpafla Medical Faculty of ‹stanbul University,       University, Isparta
  Department of Nuclear Medicine, Cerrahpafla Medical Faculty of ‹stanbul         Glaucoma may be seen as a complication in patients with COPD who require
  University, ‹stanbul                                                           treatment with nebulized bronchodilator medications. Sixty-four eyes of 32
                                                                                 COPD patients under treatment, 23 men and 9 women (mean age, 64.9±9.3
We have evaluated the relation between pulmonary function tests (PFT),           years), and thirty-two eyes of 16 controls, 12 men and four women (mean age,
thorax high resolution computed tomography (HRCT) images and quan-               64.8±8.4 years), were studied. Firstly, in order to determine the effect of

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                              117

longstanding use of steroids and bronchodilators on intraocular pressures           morphologically resembles as Neisseria. This bacteria begun to be
(IOPs) in COPD patients, baseline IOP in both eyes were measured in patients        recognized as an important pathogen since early 1980,s. It is belived that
and control subjects prior to nebulized therapy. No significancy was found in       this bacteria is involved in lower respiratory tract infections among COPD
IOPs between the control (13.8±2.4 mmHg) and study groups (14.5±2.2                 patients and also sinusitis of children. In the present investigation sputum
mmHg) (Student’s t test, p=0.98). Following baseline observations, to               of 28 patients with COPD, age range of 19-82, smokers and 100 nasal
understand the effect of nebulized bronchodilator treatment on IOPs, a study        swabs from children with sinusitis were examined for the presence of
was undertaken with four test solutions containing (1) ipratropium bromide,                                  .
                                                                                    Branhamella catarrhalis The samples were routinely cultured on sheep
500 µg (8 patients); (2) salbutamol, 2.5 mg (8 patients); (3) combined              blood agar and incubated at 37°C in the presence of 5% CO 2 for 48 hours.
ipratropium bromide, 500 µg, and salbutamol, 2.5 mg (8 patients); or (4) 0.9 %      The suspected non hemolytic, convex and circular colonies with
saline solution (8 patients) in study groups. All solutions were administered via   characteristic sliding across the agar like hockey puck on ice were smeared
face mask and mini jet nebulizer. IOPs were determined at 30, 60, 90, 120           and gram stained. B.catarrhaliswere further identified by positive oxidase,
minutes with applanation tonometry. Tests were conducted at the same time           dnae, catalase and no acid production from glucose, lactose and sucrose.
of the day to avoid diurnal fluctuations in IOPs. No significant differences in     The specimens which revealed at least 25PMN/HPF containing gram
IOPs were seen with any of the four test solutions when measurements of             negative diplococci in direct smear,were included in this study. On these
different time intervals compared to corresponding others (p>0.05 for all).         basis, B. catarrhalis were isolated from 11(39.3%) and 32(32%) cases of
When the courses of IOPs during two hour period were evaluated, a                   COPD and sinusitis respectively. The pattern of antibiotic sensitivity test
statistically significant peak in 30-60 minutes was observed for all solutions      of the isolates will be presented.
(Friedman test, p=0.000). But taking saline and amount of variations (less than
1 mm Hg) into consideration we think that this difference is not significant        PP-460 (TR)
clinically. As a result, nebulized bronchodilator treatment with ipratropium
bromide and salbutamol seems to be safe in respect to IOP changes.                  THE EFFECTS OF CARE AND EDUCATION ON SELF-
                                                                                    EFFICACY PERCEPTION IN THE PATIENTS WITH CHRONIC
PP-458 (TR)                                                                         OBSTRUCTIVE PULMONARY DISEASE

CORRELATION BETWEEN THE PULMONARY HEMODYNAMIC                                       M. Kara 1, T. Aflt› 2
AND SPIROMETRIC PARAMETERS IN PATIENTS WITH                                         1
                                                                                      University of Atatürk, College of Nursing, Erzurum
CHRONIC OBSTRUCTIVE PULMONARY DISEASE                                               2
                                                                                      University of ‹stanbul, Florence Nightingale College Of Nursing, ‹stanbul
O. Yetkin, G. Karab›y›ko¤lu                                                         This study was planned and realised in two stages to evaluate
Department of Chest Diseases and Tuberculosis, Medical Faculty of Ankara            methodologically the validity and reliance of the COPD Self-efficacy
University, Ankara                                                                  Scale Turkish Form in the patients with COPD and the nursing model was
Objective: In this study we aimed to assess the association between the             used to determine experimentally the effects of care and education on self-
spirometric test which is known to be an indicator of severity of the disease       efficacy perception. The research is carried in the Department of Chest
and pulmonary artery pressure, in patients with chronic obstructive                 Diseases of Research Hospital of the Faculty of Medicine, Atatürk
pulmonary disease (COPD). Materials and Methods: Study population                   University and Chest Diseases Hospital in Erzurum, between November
consisted of 51 patients with COPD. Severity of the disease was graded by the       2000 and August 2001. In the analysis of the data, Cronbach’s alpha,
criteria of European Respiratory Society; mildly obstructive: 5 patients            Pearson’s moment’s multiplication correlation techniques, Student’s t,
(FEV1>70%), moderately obstructive: 10 patients (FEV1=50-69%), severely             percentage, chi square, Fisher exact chi square, McNemar, and Repeated
obstructive: 36 patients (FEV1<50%). Measurement of pulmonary artery                Measures ANOVA were used. In the evaluation; • it was determined that
pressure was performed by microcatheterization method. Statistical analysis         COPD Self-Efficacy Scale Turkish Form has good test-retest reliability and
was performed between two groups; group I consisted of mildly and                   excellent internal consistency (r=0.89, á=0.94 and corrected item–total
moderately obstructive patients, and group II, severely obstructive patients.       correlation r=0.49–0.80). • There were significant increases in the cases of
Results: Pulmonary artery pressure of the group II patients was significantly       control group in terms of self-efficacy perception in the period between
higher than that of group I patients(27±4 mmHg vs 22±1.6 mmHg,                      admission and discharge (p<0.001) and between admission and one month
respectively p<0.001). There were also statistically significant differences        after discharge (p<0.01), while no significant increases in the period one
between group I and group II in respect to FEV1% (63±7 vs 28±9 respectively         month after discharge-discharge (p>0.05) was found. • There were
p<0.001), FEV1 lt (1.84±0.46 lt vs 0.89±0.36 lt respectively p<0.001),              significant increases in the cases of experimental group in terms of self-
FEV1/FVC (71±10 vs 53±11 respectively p<0.001), FVC (73±8 vs 47±10                  efficacy perception in the period of admission-discharge, one month after
respectively p<0.001) and MMF (38±13 vs 15±6 respectively p<0.001).                 admission-discharge, and one month after discharge-discharge (p<0.001).
Pulmonary artery pressure of the patients was negatively correlated with            According to evaluation results, it has been determined that self-efficacy
FEV1%, FEV1 Lt, FVC, and MMF (p<0.01 for all) Conclusion: We have                   perception can be increased by individualized patient care and education
shown pulmonary artery pressure of the patients with chronic obstructive            through the cooperation of the members of health team by enabling the
lung disease was negatively correlated with the spirometric parameters such         patient and his or her family to take part.
as FEV1, FVC, MMF. So FEV1 <50% can be used as an indicator of increased
pulmonary artery pressure in patients with COPD.                                    PP-461 (TR)

                                                                                    THE ROLE OF CD4 (+)/CD8 (+) RATIO IN DEVELOPMENT OF
PP-459                                                                              CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
                                                                                    AMONG SMOKERS
CATARRHALIS AMONG ADULTS AND CHILDREN                                               A. Kocabafl, I. Hanta, S. Kuleci
                                                                                    Department of Chest Diseases, Medical Faculty of Çukurova University,
J. Kohanteb, M. Ghayumi2, M. Hosseini Farzad2
  Department of Microbiology Shiraz Medical School, Iran
                                                                                    To assess the role of CD4 (+)/CD8 (+) cell ratio in susceptibility of
  Department of Internal Medicine Shiraz Medical School, Iran
                                                                                    development of COPD among smokers, we studied 30 healthy
Branhamella catarrhaliss a non fermenter gram negative diplococci which
                      i                                                             nonsmokers, 30 healthy smokers, 30 patients with chronic bronchitis and

118                                                                                                    TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002
 TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK                                                             POSTER PRESENTATION

38 patients with stable COPD. Heparinized blood samples were obtained            PP-463 (TR)
from all groups for CD4 (+), CD8 (+) T cells measurement in peripheral
blood by flow cytometry. We found that median percentage of CD4 (+) T            THE RELATIONSHIP OF SINUSITIS WITH ACUTE
cells were lower in patients with COPD (36.3%) than in patients with             EXACERBATIONS OF COPD AND ACUTE ASTHMATIC
chronic bronchitis (41.9%) (p<0.05) and in nonsmokers (38.1%) and in             ATTACK
smokers (36.5%) (p>0.05). However, median percentage of CD8 (+) T
cells in peripheral blood were higher among patients with COPD (25.8 %)          T. Kalc›o¤lu, M. Gök›rmak, C. Hasano¤lu, O. Özturan
than in nonsmokers (22.4%) and in smokers (21.5 %) (p>0.05). Median              Turgut Özal Medical Center, Inönü University, Malatya
CD4/CD8 ratio in peripheral blood was lower in patients with COPD
                                                                                 Although the relationship of asthma and rhinosinusitis has been revealed
(1.33) in comparison with nonsmokers (1.49), smokers (1.42) and patients
                                                                                 in several studies, the studies investigating the concomitance of sinusitis
with chronic bronchitis (1.42), but the difference was not statistically
                                                                                 with acute exacerbations of COPD are few. In this study, we have done
significant (p>0.05). We conclude that, genetically determined low
                                                                                 investigations for sinusitis in two groups of patients admitted to our clinic;
CD4/CD8 cell ratio in peripheral blood may have a role in susceptibility to
                                                                                 COPD patients with acute exacerbations and patients with acute
the effect of cigarette smoking. To clarify the importance of CD4/CD8 T
                                                                                 asthmatic attack. All patients were asked for symptoms related to sinusitis,
lymphocyte ratio in the development of COPD, we need prospective
                                                                                 rhinoscopic examinations were performed; Waters’ graphies and paranasal
studies which include larger numbers of smokers.
                                                                                 sinus CTs were evaluated. There were 19 males and 3 females in the group
                                                                                 of COPD patients (Group 1) of which the mean age was 61.6 ± 10.0. The
                                                                                 asthmatic group of patients (Group 2) consisted of 7 males and 14 females
PP-462 (TR)
                                                                                 with a mean age of 42.7 ± 11.7. Thirteen patients (59%) in Group 1 and
                                                                                 17 patients in Goup 2 (81%) had maxillary sinusitis or pansinusitis. As a
                                                                                 conclusion, sinusitis may play a role in the development of an acute
                                                                                 asthmatic attack or acute exacerbations of COPD, however, concomitance
                                                                                 of the disease is more common in patients with asthma.
A. Türközü1, E. K›yan 1, R. Berkiten , L. Genç 2, T. Ece 2, O. Arseven2
  Department of Chest Diseases, Medical Faculty of ‹stanbul University,
                                                                                 PP-464 (TR)
  Department of Microbiology, Medical Faculty of ‹stanbul University, ‹stanbul
                                                                                 THE EFFECT OF IPRATROPIUM BROMIDE USE ON
                                                                                 INTRAOCULAR PRESSURE IN COPD PATIENTS
Sputum cultures were examined in 40 patients of COPD with acute
infective exacerbations. 27 patients was men, 13 patients was women and                                                                            2
                                                                                 H. Günen1, G. Türker 1, S. Do¤anay2, M. Borazan 2, S. Hac›evliyagil
mean age was 63.5±6 years. Duration of the disease was 15.1± 10.2 years.         1
                                                                                   Department of Chest Diseases, Medical Faculty of ‹nönü University, Malatya
40% of patients (n: 16) had been hospitalized in the last one year. 17.5%        2
                                                                                   Department of Ophtalmology, Medical Faculty of ‹nönü University, Malatya
(n=7) of cases also have bronchiectasia. Pathogenic microorganism was
found in 77.5% of cases and no pathogenic microorganism was found in             Aim: Since cholinergic activity is responsible for majority of reversible
22.5% (n=9) of cases. Only one pathogenic microorganism was found in             component of airway obstruction in chronic obstructive pulmonary disase
26 culture positive patients (65%) and mixed patogenic microorganisms            (COPD), anticholinergic drugs are of the first choice. Pharmacological
were found in 14 of the patients (35%). H. influenzae (n=8, 47%),                features of ipratropium bromide (IB) are smilar to atropine with a less side
Klebsiellapneumoniae(n=3, 17%), β-lactamase negative H. parainfluenzae           effect. We tried to study effect of IB on intraocular pressure (IOP).
(n=1, 0.6%), Streptococcus pneumoniae  (n=1), Metisillin sensitive S. aureus     Material and Method: We classified patients into two groups. In Group 1,
(n=1), E. coli (n=1), M. catarrhalis(n=1), nonfermentative Gram negative         there were 22 COPD patients (mean age, 61.77±13) using IB inhaler
rods (n=1) were found in the patients with one pathogenic microorganism.         (MDI) and/or nebulizer forms for a mean time of 63±13.53 months (1-36).
In mixed culture positive patients, H. influenzae (n=8), Pseudomonas             In group 2 there were 16 newly diagnosed COPD patients (mean age
(n=5), Proteus miribalis(n=3), Klebsiella pneumoniaen=2), M. catarrhalis         51.25±13.39) who have not used IB yet. In both groups there were no
(n=2), Enterobacter(n=2), Gram negative rods (n=2), Citrobacter(n=1),            steroid use and no known other ocular pathology. Detailed ocular
methycillin sensitive coagulase negative Staphylococcus n=1) were found.         examination and IOP measurements have been done within 2 hours after
Of 31 pathogenic microorganisms, 14 (45%) was H. influenzae and only             two puffs (40 mcg) IB inhalation. Both groups were compared statistically.
one of these microorganisms was resistant to β-lactamase. Mixed                  Findings: IOP measurements of right and left eyes in group 1 were
pathogenic microorganisms were found in the most of patients with                12.86±2.51 and 12.68±2.71 mmHg, respectively and 13.19±2.64/
bronchiectasia (71.4%) As a result, the most common pathogenic                   13.06±2.41 mmHg respectively in group 2. In both goups IOP were within
microorganism was H. influenzae with 92% β-lactamase sensitivity in              normal limits. Also there were no statistically significant difference
COPD-infective exacerbations.                                                    between two gropus. Conclusion: We concluded that there was no IOP
                                                                                 increase in stable COPD patients using inhaler IB.

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                              119

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