POSTER DISCUSSION 26 April 2002_ Friday

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					                                                                  POSTER DISCUSSION
                                                                  26 April 2002, Friday

PD-290 (TR)                                                                         positive cultures were obtained in 91 (74%), mostly from the sputum, rarely
                                                                                    from the CSF, urine, exudate, bone marrow, etc. Histological Dg was
EVALUATION OF 934 TUBERCULOSIS PATIENTS                                             established in 33 (27%) pts (pl. biopsy - 4, bronchoscopy - 11, FNAB - 4,
ENROLLED IN EfiREFPAfiA TUBERCULOSIS DISPENSARY                                       open lung biopsy - 4, other in 10 pts). Early Dg of miliary TB (ARB +
(1996-2000)                                                                         histology) was established in 75 (61%) pts. AT drugs resulted in withdrawal
                                                                                    of pulmonary findings over 2-3 months, more rapidly in younger patients.
‹. Coflkunol1, S. Alptekin, M. Ayd›n1, D. Tatar 2, S. Arslangiray2,
                                                                                    Fatal outcome ensued in 18 (15%),. Conclusions: Although hematogenous
H. Çelikhisar                                                                       TB has been an old disease, some clinical presentations have been an entirely
  Eflrefpafla Tuberculosis Dispensary, ‹zmir                                          new clinical experience, more interesting than the statistical account.
  ‹zmir Chest Diseases and Thoracic Surgery Training and Research Hospital,
                                                                                    PD-292 (TR)
Esrefpasa Tuberculosis Dispensary studies were evaluated with the targets of
National Tuberculosis Control Program produced according to The World               EVALUATION OF TUBERCULOSIS PATIENTS AND NEW
Health Organization proposal. We evaluate the records of tuberculosis (TB)          CASES DIAGNOSED DURING THE EXAMINATION OF
patients during the last six years retrospectively. Of the total number of 934      THEIR CONTACTS
patients, 647 (69.3%) were male, 287 (30.7%) were female and the mean
age was 33.5±16.4’tü. 756 (80.9%) had pulmonary TB, 178 (19.1%) had                 S. Alptekin, ‹. Coflkunol, M. Ayd›n
extrapulmonary TB. There was the history of TB contact in 33.1% of                  Eflrefpafla Tuberculosis Dispensary, ‹zmir
patients. 25.2% of the patients had no bacillus Calmette-Guerin (BCG)               Since to contact with a tuberculosis (TB) patient is a risk factor for the
vaccine scatrix. 428 (51.1%) of 837 (89.6%) new cases were sputum                   transmission of TB, examination of the contacts of tuberculosis patients is
positive. By estimating the expected new sputum positive cases in our               important not only in the prevention of TB, but also for the diagnosis of
region,the rates of case detection were found as to years respectively; 72.5%,      new patients. This study is designed to evaluate clinical, social and
70.6%, 73.5%, 73.3%, 83.7% and 83.7%. The rate of treatment success and             demographic properties of 64 of the enrolled patients between January
the cure rates of new sputum positive cases were found as to years                  1996 to December 2001 (Group 1) and 97 patients, who were diagnosed
respectively; 84.9%-79.7%, 87.7%-63.9%, 91.9%-80.0%, 89.0%-71.4%,                   during the examination of their contacts (Group 2). Fifty-nine (92.2%) of
92.8%-65.3% ve 55.8%-55.6% (the treatment of 57 patients is going on).              Group 1 had pulmonary TB. On chest radiographs ,cavitation was found in
While the rate of the patients,who completed the treatment without                  34 (53.1%) patients. Forty-six (71.9%) patients had smear and culture
interruption was 72.3%, 13.8% of the patients interrupted their treatment           positive sputum. Thirty-four (69.4%) of 49 patients, whose semptomatic
lower than two weeks. National Tuberculosis Program which was produced              periods have been recorded, were diagnosed within 3 months. 359 (89.1%)
according to The World Health Organization targets to find 70% new cases            of their 403 contacts were examined; 161 (75.6%) of 213 had positive
and 85% treatment success to 2005. According to this proposal Eflrefpafla             tuberculin skin test, 206 (57.4%) were given chemoprophylaxis. While
Tuberculosis Dispensary continues its studies in order to increase finding          there was no interruption in the treatment of 40 (62.5%) patients, 6
new cases and treatment success rates.                                              (9.4%) intterrupted more than 8 weeks. 90.6% of the patients completed
                                                                                    the treatment successfully. The mean age of Group 2 was 23.4±15.4.There
PD-291                                                                              was no bacillus Calmette-Guerin (BCG) vaccine scatrix in 21 (21.6%)
                                                                                    patients. Twenty-three (23.7%) patients have been given
HEMATOGENOUS TUBERCULOSIS - 123 CASES                                               chemoprophylaxis, but 9 (39.1%) of them used the drugs irregularly.
                                                                                    Chemoprophlaxis have not been given to many of the sporadic contacts
G. Radosavljevic, D. Jovanovic, S. Krstic, M. Ercegovac
                                                                                    (p=0.022). Thirty-four (35.1%) patients were diagnosed at the first clinic
Institute for Lung Diseases and Tuberculosis, Yugoslavia
                                                                                    visit. The relation between cavitary TB and smoking cigarette was
Introduction: Although hematogenous TB is rare, it should be overlooked in          significant (44% versus 20%; p=0.034). The results of the study confirmed
the light of increasing incidence of TB worldwide. The non-classic forms are        that; contact examination is a basic method of finding new TB patients
a diagnostic problem. Methods: The retrospective study of 123 hospitalized          and emphasized the importance of examining not only the household, but
patients with miliary lung TB at our hospital. Results: In the last 14 years, out   also the sporadic contacts and giving them chemoprophylaxis regularly.
of 7299 hospitalized pts with lung TB, there were 123 (1.7%) hematogenous
TB (5-12 pts per year). Age: 17-82. In 52 (42%) of them there were
                                                                                    PD-293 (TR)
predisposing diseases. Two pts had HIV infection. Primary miliary TB was
registered in 3 cases (age: 17, 19, 21) all without BCG vaccination. Loss of
                                                                                    RESISTANCE PATTERN OF TUBERCULOSIS PATIENTS
body weight and fever were the most common symptoms. Classical x-ray
                                                                                    ENROLLED IN ‹ZM‹R EfiREFPAfiA TUBERCULOSIS
miliary findings existed in 104 (85%), atypical and scarce in 19 (15%). Other
                                                                                    DISPENSARY (1996-2000)
x-ray changes were small cavities in 18 (15%), pleural effusion in 11 (9%),
pericarditis in 5 (4%), enlarged mediastinal nodes in 7 (6%), etc.
                                                                                    ‹. Coflkunol, S. Alptekin, M. Ayd›n
Bacteriological and/or histological confirmation of TB was obtained in 114
                                                                                    Eflrefpafla Tuberculosis Dispensary, ‹zmir
(93%) patients. In 9 (7%) clinical Dg and AT drug test were sufficient.
Directly positive ARB sputum was present in 42 (34%) pts. Lowenstein                The problem of drug-resistance in tuberculosis (TB) is gradually increasing in

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

many parts of our country and throughout the world. To contribute the data         was detected in 87 (23.8%) patients. For all patients, resistance to isoniazid
of our country,the records of drug-resistant TB patients were evaluated during     was most common (54 patients) followed by resistance to ethambutol (39
a six year period retrospectively. Among a total number of 934 patients 531        patients), rifampicin (11patients), and streptomycin (9 patients). One
(56.7%) had culture positivity, in 453 (85.3%) of them drug sensitivity test       drug resistance was detected in 69 patients, two drug resistance 11 patients,
results had been recorded. There were 394 (87.0%) new and 59 (13.0%)               three drug resistance 6 patients, and four drug resistance one patient.
previously treated patients. Of 97 (21.4%) patients, who had resistance to at      Multi-drug resistance (resistance to at least isoniazid and rifampicin) was
least one anti-TB drug,total initial resistance rate was 80.4% (n=78). Initial     detected in 10 patients. In logistic-regression analysis, primary drug
resistance rates for each anti-TB drugs were as follows; for isoniazid (H) 5.6%,   resistance was associated with radiological advanced tuberculosis
for rifampicin (R) 6.1%, for streptomycin (S) 9.9% and for ethambuthol (E)         (p<0.001). High primary drug resistance represents a major problem in
6.3%. Total acquired resistance rate was 19.6% (n=19). Acquired resistance         Turkey. Therefore, regular surveillance of drug sensitivity pattern should
rates for each anti-TB drugs were as follows; for H 15.3%, for R 15.3%, for S      be maintained to determine alternate drug regimens and to detect the
18.6%, for E 11.9%. Initial and acquired multi-drug resistant tuberculosis         spread of resistant strain in our country.
(MDRTB) rates were 1.2% and 8.5% respectively. Resistance was frequent in
female patients (p=0.025). A significant relation was found between close
contacs and drug resistance (p=0.029). Generaly,rates of patient adherence         PD-296
and treatment success were 89.1%-86.1% in our dispensary. As a
conclusion,in this study, the rates of acquired resistances seperatly and          SURGICAL TREATMENT IN PATIENTS WITH
MDRTB were lower than the data of our country, while the rate of initial           MULTIRESISTANT TYPE OF PULMONARY TUBERCULOSIS
resistance was similar. This may be related to the referance of these patients
to highly specialized centers by the endorsement of National Tuberculosis          K. Aliyev, F. Medjidov, T. Taghi-Zada
Control Program. In addition, there may be a relation with the high rates of       Scientific Research Institute of Lung Diseases, Baku, Azerbaijan
patient adherence and treatment success in our dispensary.
                                                                                   According to latest literary data the amount of the patients with
                                                                                   multiresistant type of destructive pulmonary tuberculosis steadily grows.
PD-294                                                                             Chemotherapy of such patients is inconvenient and without operative
                                                                                   treatment in most cases does not bring any positive outcomes. We possess
TUBERCULOSIS IN NAMANGAN AREA OF REPUBLIC OF                                       experience of surgical treatment of 16 patients with fibro cavernous smear-
UZBEKISTAN                                                                         positive pulmonary tuberculosis with multiresistant MBT strain (in 68% of
                                                                                   the patients was resistance to 3, and in 32% - to 4 antituberculous drugs)
                1                            2
A. Ubaydullaev, G. Uzakova 2, A. Yuldashev, U. Mahmudov2                           was determined. All patient were carried out preoperative preparation
  Scientific Research Institute of Tuberculosis and Lung Diseases, Uzbekistan      (chemotherapy, immunocorrection, bronchoscopy, detoxication therapy,
  Republican DOTS Center, Uzbekistan                                               physiotherapy, plasmapheresis etc.). In the present group of the patients
                                                                                   were made pulmonectomy - 2, lobectomy- 3, thoracoplasty - 11 (from them
Namangan area has 1 900 000 population. Fertility rate is 21.0, mortality          in 5 patients is made six-ribs, and at 1 patient - five-ribs thoracoplasty).
is 5.1, repeatability rate is 15.9 per 100 000 population. TB mortality            Lethal cases were not marked. Postoperative period in 14 patients passed
decrease from 71.4 per 100 000 population in 1975 till 38.1 per 100 000 in         off without complications. In 1 patient was marked suppuration of
1990. Since 1990 the situation changes, in 2001 TB morbidity was 61.1 per          postoperative wound, at 1 - pneumonia. The indicated complications were
100 000 population, TB morbidity among children - 51.8 per 100 000                 eliminated. Hereinafter condition of the patients remained stable. Thus,
population which evidence of high level of the infection transmission              the surgical method of treatment in patients with multiresistant type of
among population and lot of patients not diagnosed. In September of 2001           destructive pulmonary tuberculosis promotes effective treatment and
year Namangan oblast has involved in DOTS program. Behind period                   stabilization of process. It is necessary to mark, that the collapsosurgery was
September 2001 - January 2002 there were registered 116 patients - 55, 33,         preferred as a method of a choice.
28 patients from category 1, 2, 3 accordingly. There are 28 new smear
positive cases, 4 relapse smear positive cases, 60 smear negative cases, 24
extrapulmonary cases. Uzbek government purchased all TB drugs for                  PD-297 (TR)
DOTS implementation program in Namagan area. The training courses
provided by specialists from Republican DOTS center in rural level.                DRUG RESISTANCE TO TUBERCULOSIS IN AEGEAN REGION

                                                                                   S. Güneri1, I. Ünsal 2, A. Öztop 2, M. Erkut 2, V. Avkan O¤uz3, R. Çakmak3
PD-295 (TR)                                                                         Kahramanlar Local Laboratory for Tuberculosis, Tuberculosis Dispensary,
OUR CASES WITH PRIMARY ANTI-TUBERCULOSIS DRUG                                        Kahramanlar Tuberculosis Dispensary, ‹zmir
RESISTANCE USING BACTEC METHOD                                                       Department of Infectious Diseases and Clinical Microbiology, Medical Faculty
                                                                                     of Dokuz Eylül University, ‹zmir
Z. Kartalo¤lu1, E. Bozkanat 1, H. Öztürkeri 2, O. Okutan 2, A. Ilvan2
  GATA, Department of Chest Diseases of Haydarpafla Training Hospital,              The aim of the study was to determine primary, secondary and total
  ‹stanbul                                                                         resistance to tuberculosis strains in Aegean Region. Five hundred twenty
  GATA, Çaml›ca Chest Diseases Hospital, ‹stanbul                                  nine samples from twenty-seven tuberculosis dispensaries between November
                                                                                   1999 and 2001 were evaluated. Strains identified as Mycobacterium
The aim of this study was to investigate the prevalence of primary                 tuberculosis by using colony morphology, growth rate and standard
antituberculosis drug resistance in our hospital. We evaluated the clinical        biochemical procedures were searched for isoniasid, rifampycin and
data and radiological features from newly diagnosed 365 patients with              ethambutol sensitivity by using indirect proportion method. HRv37,
culture positive pulmonary tuberculosis were analyzed using the BACTEC             ATCC35838 and ATCC35825 were used as standard origins. Patient
method. Drug-susceptibility testing was performed for isoniazid,                   information was collected from 474 subjects. The observations were made on
rifampicin, ethambutol, and streptomycin. All of patients have not taken           387 (81.65%) patients who received no prior antituberculous therapy, 87
anti-tuberculosis drugs previously. Primary resistance to 1 or more drugs          patients (18.35%) who received antituberculous therapy longer than one

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                                   77

month. Primary resistance rate was 18.35%, secondary resistance rate was         mentioned form is inserted and processed by a standard set of variables in a
32.18% and total resistance rate was 20.89%. Total primary resistance for        computer program for epidemiology 2EPI INFO 6.042 after which a
isoniasid (I) was 12.14%, followed by streptomycin 10.85% rifampycin (R)         standard statistical processing is done in a computer package 2Office 2000-
5.68% and etambutol (E) 1.29%. Total secondary resistance rates were as          Word2. Results: In 1997. there was totally 1820 reported cases of TB of all
follows; 27.59% for I, 19.54% for R, 12.64% for S and 5.75% for E. Total         localisations and of that 175 (9.6%) was EPT, in 1998 of totally 2060
resistance rates were; 14.98% for I, 8.23% for R, 1.18% for S and 2.32% for      reported cases of TB of all localisations 235 (11.4%) was EPT, in 1999. of
E. Primary resistance rate was 10.85% for 1 drug, 3.88% for 2 drugs, 2.58%       totally 2070 reported cases of TB of all localisations 259 (12.5%) was EPT,
for 3 drugs, 1.03% for 4 drugs and 4.39% for I+R. Secondary resistance rate      in 2000. Of totally 1762 reported cases of TB of all localisations 198
was 13.79% for 1 drug, 8.05% for 2 drugs, 6.90% for 3 drugs, 3.45% for 4 drugs   (11.2%) was EPT. Of all types of EPT most frequent was the pleural form.
and 17.24% for I+R.Total resistance rate 11.39% for 1 drug, 4.64% for 2          It is obvious that there is a small number of meningitis. Conclusion: Results
drugs, 3.38% for 3 drugs, 1.48% for 4 drugs and 6.75% for I+R. In conclusion,    of the research show that the frequency of EPT during the searching period
drug resistance continues to be a major problem that needs to be solved.         1997-2000 in FBiH is slightly lower than the frequency of this form of TB
                                                                                 in developed countries. The frequency of pleural,genito-urinary and
                                                                                 lymphatic form of EPT is the greatest considering all other forms of EPT in
PD-298 (TR)                                                                      FBiH during the analization period. This kind of epidemiological frequency
                                                                                 of EPT as well as some forms of EPT is a characteristic of countries have
TRENDS IN ANTITUBERCULOUS DRUG RESISTANCE                                        been engaged in war and that are in the post-war period.

B. Dursun, M. Güler, M. Atasever
Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital,      PD-300 (TR)

To investigate the trend of antituberculous drug resistance between 1990         THE ROLE OF SMOKING ON PULMONARY FUNCTIONS IN
and 2000, we conducted reviewing the records of bacteriology laboratory of       PATIENTS WITH MITRAL VALVE DISEASE
the hospital by computer. Lowenstein-Jensen culture media and proportion
method for drug susceptibility testing were used in this period. Drug            N. Gürses, S. Özy›lmaz, R. Demir, R. Olga, Ö. Güven
resistance was classified as monoresistance (MR), compound resistance (CR)       Institute of Cardiology, University of ‹stanbul, ‹stanbul
and multidrug resistance (MDR). Number of materials detected per year            Objective: The aim of this study was to evaluate the role of smoking on
ranged between 17 186 and 23 685; 1-2.4% (208-446/year) of them were             pulmonary functions of patients with mitral valve disease (MVD) that
resistant. In the resistant group, MR, CR and MDR ranged between 38.46%,         were diagnosed in our clinic. Method: The files and records of the patients
1.5%, 24.91% and 44.48%, 33.33%, 44.71%, respectively. MR has been               seen in our clinic were reviewed to identify patients’ data including
rising since 1994, whereas CR has been declining since 1995. Although            demographic characteristics, spirometric tests and smoking habits. 189
MDR declined between 1992 and 1996, it’s in rising trend since 1997. The         patients constituted the study population. Among these patients 72 were
most common MR (62%) was against to streotomycine (S), sequentially              male (51 smokers: mean age 45.5±12.3; 21 nonsmokers: mean age
26.8% to rifampicine (R) and 18.3% to isoniaside (H). Mono ethambutol            46.9±18.5), and 117 were female (31 smokers: mean age 43.4±13.7 ; 86
(E) resistance was found just in one material. Resistance to S and H reached     nonsmokers: mean age 45.4±13.6). The percent of predicted values of
to peak levels in 1996 and 1993, respectively and then both declined. But in     spirometric parameters were compared both in male and female patients
1997, H resitance began to rise again. In 1995, resistance to R reached to the   with regard to their being either smoker or non-smoker. Student t-test has
peak level was 33.33% and fluctuated during investigated period. We              been used for the statistical analysis of the data. Results: When
concluded that these resistance ratios reflect antituberculous therapy applied   spirometric parameters of the patient groups were compared, it was
in our country. Detected high S resistance and nonsignificant E resitance        observed that male smokers had a significant decrease in FMF% (p<0.02),
provide superiority to E to be chosen as fourth drug in treatment protocol.      FMFT (p<0.06) and FEV1/FVC (p<0.005) compared to male nonsmokers.
Rising in both MR and MDR indicate that national tuberculous control and         Even though female smokers’ results were slightly worse than female
therapy programme is not enough as much as it’s desired, yet.                    nonsmokers, the results were similar rather than having a significant
                                                                                 difference. Male smokers had a significantly higher cigarette consumption
PD-299                                                                           per day (26.2±20.2 versus 16.9±9.8; (p<0.03) and duration of smoking in
                                                                                 years (20.8±9.7 versus 14.3±8.3; p<0.008) compared with female smokers.
EPIDEMIOLOGICAL CHARACTERISTICS OF                                               Conclusion: We conclude that MVD is a clinical condition with a
EXTRAPULMONARY TUBERCULOSIS IN THE FEDERATION                                    decrease in pulmonary functions and duration of smoking and
BOSNIA AND HERZEGOVINA                                                           consumption of cigarettes per day effect this deterioration.

A. Ustamujic, Z. Dizdarevic, H. Zutic, V. Cukic, Z. Hadzimurtez›ic
Clinic for Lung Disease and Tuberculosis Sarajevo, Bosnia-Herzegovina            PD-301 (TR)

According to the definition by the WHO and IUATLD extrapulmonary                 A RARE CASE: CHRONIC EOSINOPHILIC PNEUMONIA
tuberculosis (EPT) presents tuberculosis of any organ, except when the lung
                                                                                 Ç. Biber, Ü. Y›lmaz Turay, P. Ergün, A. Keyf, E. Özayd›n, Y. Erdo¤an
parenchime is affected with a specific process. The aim is to establish the
                                                                                 Atatürk Chest Diseases and Thoracic Surgery Center, Ankara
frequency of EPT of all localisations, the frequency of some forms and other
epidemiological characteristics of EPT in FBiH. Materials and Methods:           A patient, presenting with cough, dyspnea and rhinitis for 11 years was
There was an retrospective analysis of the reported cases of all localisations   hospitalised several times with the diagnosis of bronchial asthma, Loeffler’ s
within the area of FBiH with a special insight in EPT. An analysis was made      pneumonia and interstitial lung disease. The patient’s IG E levels and
for all reported cases of TB of all localisations in FBiH during the period      number of eosinophils were found as high in each hospitalisation and the
from 1997 to the year 2000. A standard set of data was used for TB patients      lesions of migrating origin with the predominance of upper zones were
and was included in the standardized form 2Minimum information for               observed in chest radiograph. Since the attacks presented with severe
reporting tuberculosis 2 which is used according to the recommendation of        wheezing and dyspnea the corticosteroid therapy was initiated before the
the WHO and IUATLD in Europe and elsewhere. Data from the                        invasive procedures. so that, histopathologic examination of several

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

transbronchial bronchoscopic biopsies and one open lung biopsy revealed          ly for diffuse pulmonary diseases that otherwise have not been able to be
nonspesific findings. In the last hospitalisation during the another attack, a   diagnosed by means of less invasive procedures. This study aims to investi-
transbronchial biopsy and biopsi from the diffuse noduler lesions observed on    gate the diagnostic value of open lung biopsy in view of different clinical
the tracheobronchial tree were taken by bronchoscopy, the histopathological      aspects. Material and Method: Fifty-five patients undergoing open lung
examinations of the biopsies revealed findings in consistent with chronic        biopsy via mini-thoracotomy or VATS between 1994 and 2001 were ret-
eosinophilic pneumonia.                                                          rospectively reviewed in terms of their demographic features, site for biop-
                                                                                 sy, postoperative complications and histopathological diagnosis. Results:
                                                                                 There were 37 (67%) male and 18 (33%) female patients with a mean age
PD-302 (TR)
                                                                                 of 38±15 (range 12-75). Biopsy was performed via mini-thoracotomy or
                                                                                 VATS in 50 and 5 patients respectively. Tissue specimens were obtained
RESULTS OF A QUESTIONNAIRE OF INHALER                                            from upper or lower lobes in 36 (65%) and from lingula or middle lobes in
                                                                                 19 (35%) patients. Median drainage time and hospital stay were 3 and 5
                                                                                 days respectively. Postoperative complications occurred in 9 (16%)
                                                                                 patients. Of them, 6 patients sustained prolonged air leak, 2 patients were
E. fien, Z. Ekici, U. Gönüllü
                                                                                 left with a small apical space and one patient required re-thoracotomy for
Department of Pulmonary Diseases, Medical Faculty of Ankara University,          bleeding. Definite histopathological diagnosis was achieved in all but one
                                                                                 patient. Biopsy result has altered the preoperative suspected clinical diag-
This study was aimed to evaluate the effects and place of some parameters        nosis in 35 (64%), and confirmed it in 19 (35%) cases. Conclusion: Given
about the inhaler treatment practice and usage in outpatient and inpatient       its low mortality and morbidity rates, ease of surgical technique and high
settings of a pulmonary diseases department of a university hospital. This       diagnostic value, open lung biopsy should be considered for the diagnosis
questionnaire was applied to the outpatients and inpatients used before          of pulmonary parenchymal diseases if less invasive diagnostic procedures
and/or using an inhaler form of therapy between February 2001 and May            fail to prove a definite diagnosis.
2001. Patient’s age, number of hospital stay, form of inhaler therapy,
knowledge of diagnosis, duration of therapy, education of using the therapy,     Table of Histopathological Diagnosis
correct application technique, continuity of therapy were evaluated.             Interstitial Lung Diseases: n=34 (62%); Other Diseases: n=21 (38%)
Statistical analysis was made by SPSS 10.0. While in outpatients’ (n=145)        Interstitial fibrosis: 11; Tuberculosis: 9; Histiocytosis X : 7
and inpatients’ (n=55) groups, the most selected form of inhaler therapy was     Sarkoidosis: 1; Honeycomb lung: 2; Malignancy: 4; Usual interstitial pneumonia: 8
being metered dose inhalers, in inpatients’ group, the usage of nebulisators     Pneumoconiosis: 2; Desquamative interstitial pneumonia: 2;
was more common. A significant relation was determined between patient’s         Organizing pneumonia: 2; Giant cell interstitial pneumonia: 2; Pseudo-tumour: 1
                                                                                 Churg-Strauss Syndrome: 1; Pulmonary oedema: 1; Extrinsic allergic alveolitis: 1
age and correct application technique (p<0.05) and knowledge of the
                                                                                 No diagnosis: 1; Interstitial lung disease (NOS): 1
diagnosis (p<0.001) with Studen-t test. Younger patients were more
conscious of their diagnosis and correctly applicating the inhaler therapy
than aged patients. A significant relation (p<0.05) was observed between         PD-304 (TR)
duration of therapy and correct usage technique with Mann-Whitney U test
(mean duration of therapy of incorrect users was 40.97±42.97 months,             PULMONARY FUNCTION TESTS IN MYELODYSPLAST‹C
correct users- 29.42±37.89 months). Education of using the therapy and           SYNDROME
correct application technique were also statistically related (p<0.001). An
interesting result was that there was no relationship between the educational    M. Erelel1, R. Küçükkaya2, Ç. Çuhadaro¤lu1, M. Yenerel2, A. Yavuz 2,
level and correct application technique, knowledge of diagnosis, continuity      B. Kumbasar3, M. Tunac› 3, M. Nalçac›3, G. Dinçol3
of inhaler therapy. There were statistically significant relations between the   1
                                                                                   Department of Pulmonary Disease, ‹stanbul Medical Faculty of University
number of hospital stay and correct application technique, knowledge of            of ‹stanbul, ‹stanbul
diagnosis and continuity of inhaler therapy. Mean number was higher in             Division of Hematology, Department of Internal Medicine, ‹stanbul Medical
patients knowing their diagnosis, correctly using the therapy and still            Faculty of University of ‹stanbul, ‹stanbul
continuing to use. To obtain the compliance of inhaler therapy, the most           Department of Radiology, ‹stanbul Medical Faculty of University of
efficacious factors was to give enough information about the therapy and           ‹stanbul, ‹stanbul
their illness. Furthermore, to give an adequate education of usage is the most
important tool determining the treatment success, correct application, also      Myelodysplastic syndrome (MDS) is a group of clonal hematological
this may be seen like a responsability.                                          disorders characterized by refractory cytopenia and increased risk of
                                                                                 transformation to acute leukemia. Respiratory problems, which are mostly
                                                                                 caused by infections, may be seen in this group of patients due to leukopenia
PD-303 (TR)                                                                      or defective white blood cell functions. Non-infectious pulmonary
                                                                                 involvement is extremely rare in the literature. We evaluated 15 DS
DIAGNOSTIC VALUE OF OPEN LUNG BIOPSY IN                                          patients with no pulmonary symptoms. Diffusion capacity values were
PULMONARY PARENCHYMAL DISEASES                                                   decreased in 9 of 15 cases (60%). Obstruction in the pulmonary function
                                                                                 tests was detected in 10 of 15 cases (66.7%) and decreased diffusion
G. Olgaç1, A. Demir1, H. Ak›n1, E. Çetinkaya2, N. Ürer 3, M. Bedirhan3,          capacity was together in 6 of 15 (40%) cases. Abdominal magnetic
A. Gürses3                                                                       resonance (MR) imaging was performed to 13 patients for to evaluate
  Yedikule Chest Diseases and Thoracic Surgery Centre, Department of             secondary hemochromatosis. Nine patients (69.2%) were found to have
  Thoracic Surgery, ‹stanbul                                                     decreased liver signal intensity on T2-weighted images, suggesting iron
  Yedikule Chest Diseases and Thoracic Surgery Centre, Department of Chest       overload. Six out of 9 patients (66.7%) who had hepatic iron overload also
  Diseases, ‹stanbul                                                             had decreased diffusion capacity values. We could not perform invasive
  Yedikule Chest Diseases and Thoracic Surgery Centre, Department of             procedures such as bronchoalveolar lavage or transbronchial biopsy in our
  Pathology, ‹stanbul                                                            MDS patients with no pulmonary symptoms. We suggest that decreased
                                                                                 diffusion capacity values and obstruction in the pulmonary function tests
Background and Objective: Open lung biopsy is frequently performed for           may develop in MDS patients who had secondary hemochromatosis, and
the diagnosis of many pulmonary diseases with unknown aetiology, main-           our findings may be related to iron overload in the lung.

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                                    79

PD-305 (TR)                                                                       After a 2 week treatment period, the drainage of the fistula was stopped and
                                                                                  was graphy of ESD confirmed by control barium contrast. And then oral
THE CLINICAL IMPORTANCE OF THE ANATOMICAL                                         intake was started and on his course no fistula developed again. He had no
SEVERITY OF PULMONARY THROMBOEMBOLISM                                             symptoms on his follow up of four months since then. We presented this case
                                                                                  to show the spontaneously closure of GPF without necessitating
M. Habeflo¤lu1, I. O¤uzülgen1, N. Ekim 1, K. Demirel2, E. Çelik 2                  interventional surgical treatment.
  Department of Pulmonary Diseases, Medical Faculty of Gazi University,
  Department of Nuclear Medicine, Medical Faculty of Gazi University, Ankara      PD-307

Pulmonary thromboembolism (PTE) is a disease that has different clinical          CLINICAL PRESENTATION OF THYMOMA: 11-YEAR’S
presentations ranging from a single pulmonary symptom to hemodynamic              EXPERIENCE
shock. The aim of this study is to assess the effect of the anatomical
severity of the disease to its clinical presentation and to determine the role                   1                                 2
                                                                                  D. Jovanovic, S. Pavlovic2, L. Nagorni-Obradovic, A. Blanka2, S. Popevic2
of risk factors in the anatomical severity of PTE. 121 PTE patients (65             Institute for Lung Diseases and TB, Clinical Center of Serbia, Belgrade,
female, 56 male, aged 58±15.1) were investigated. To assess the                     Yugoslavia
anatomical severity of PTE scintigraphically detectable pulmonary                   Institute for Nuclear Medicine, Clinical Center of Serbia, Belgrade,
vascular obstruction was scored (PVOs). Patients with PVOs>50% were               Yugoslavia
compared to those with PVOs <50% for their clinical parameters and risk
factors. 70 patients had PVOs <50% (mean 36.6±8.3%) and 51 had PVOs               During the period 1991-2001, at the Institute of Lung Diseases 24 cases of
>50% (mean 62.2±9.4%). Patients with PVO >50% were significantly                  thymoma were diagnosed and treated. Male to female ratio was 14: 10
older than those with PVO <50% (mean ages were 62.1±14.4, 55.1±14.9,              (58.3% : 41.7%) with the average age of 56 years (ranging from 21 to 74
p<0.01 respectively). There was no significant difference between the             years). The most frequent symptoms were : dry cough-in 20 pts (83.3%), in
groups when they were compared according to their respiration rate, pulse         majority of them lasting for 1-4 months before the diagnosis was established,
and blood pressures. Patients with PVO >50% had significantly worse               only in 3 patients it was present more than 1 year, dyspnea-in 12 patients
arterial blood gas parameters than those with PVOs <50% [PO2, PCO2                (50%) (duration being 2-3 months mainly), thoracic pain-in 13 patients
(mmHg) and O2Sat (%) were 59.3±9.9, 30.4±7, 90.4±5.5; 66.3±10.4,                  (54.2%). Systemic syndromes were verified in 7 patients (29.2%): in one
33.9±5.5, 92.8±2.8, p<0.01 in patients with PVOs >50% and <50%                    SLE was diagnosed 3 years before the diagnosis of thymoma was established,
respectively]. There was no significant difference between the groups with        and its signs were not evident any more after the removal of thymoma; 4
regard to their symptoms. Both groups had nearly the same number of risk          patients had the diagnosis of Myasthenia gravis before the tumor was
factors (the number of risk factor per patient for the group with PVOs            evidenced, one patient had polyneuropathy and another one amenorrhoea.
>50% and <50% were 2.5, 2.4 respectively). Presence of operation,                 Most of theme were localized only in the anterior mediastinum, with the
immobilisation, major trauma, deep venous thrombosis, obesity and                 exception of 5 pts (20.8%) in whom it was also evident in the superior
malignity as a risk factor were similar in both groups. In conclusion, the        mediastinum and in one pt in the middle mediastinum as well. Thirteen pts
anatomical severity of PTE do not effect its clinical presentation and is not     (54.2%) had the thymoma greater than 10 cm in diameter. The diagnosis
affected from the presence of different clinical risk factors. Only it effects    was established by percutaneous biopsy in 19 pts (79.2%), and by explorative
arterial blood gases as a result of its influence on pulmonary gas exchange.      thoracotomy in the remaining 6 pts (20.8%). Seventeen pts (70.8%)
The clinical severity of PTE is independent of its anatomical severity            underwent operation. At the operation the thymoma was found to infiltrate
which is determined by the existing cardiopulmonary reserve.                      surrounding structures (aorta, pericardium, lung) in 7 pts (29.2%), chest wall
                                                                                  in 2 pts (8.3%); in 3 pts metastases (mts) in both lungs were evidenced,
PD-306 (TR)                                                                       while distant mts were registered in 4 pts (16.7%) (in retroperitoneal and
                                                                                  parapancreatic lymph nodes, and in adrenal gland as well). Hystological
A CASE REPORT: SPONTANEOUS CLOSURE OF A                                           analyses revealed well-incapsulated “benign” thymoma in 8 pts (33.3%); in
GASTROPLEURAL FISTULA                                                             the remaining 16 cases (66.7%) the thymoma has invaded the adjacent
                                                                                  mediastinal structures.
fi. Savafl1, E. Türk 2, fi. Akçay2, A. Harman 3, Ö. Karacan 3
 Department of Pulmonary Diseases, Medical Faculty of Baflkent University,
  Ankara                                                                          PD-308 (TR)
  Department of General Surgery, Medical Faculty of Baflkent University, Ankara
  Department of Radiodiagnostic, Medical Faculty of Baflkent University, Ankara    ENDOBRONCHIAL HAMARTOMA (9 CASES)

A 36-year-old man admitted to our center because of drainage of a purulent        O. Kula, H. Alt›nöz, O. Yaz›c›o¤lu, P. Pazarl›, B. Keser, T. Karagöz
material from his left pleural catheter which was placed in another center.       SSK Süreyyapafla Thoracic Diseases Training Hospital, ‹stanbul
On his past medical history, a traffic accident at 8 years of age was present
and then progressive dyspnea had developed, following this accident. An           Pulmonary hamartoma is one of the most seen benign tumors of the lung.
abdominal operation had been performed to repair the diaphragmatic                Histologically it is a combination of mature hyaline cartilage, fibromyxoid
rupture in 1998. He kept on drainage and antibiotic treatments against the        stroma and mature lipoid tissue. 90% is seen as solitary, parenchymally
graft infection but the drainage from the pleural catheter was persisting since   peripherical mass. Most are asymptomatic. 8-10% is endobronchially
the operation. On his admission he had a pleural drainage catheter under his      localized and in these cases cough, hemoptysis, recurrent pulmonary
left scapula in which gastric contents and purulent material noted. On            infections are seen. In this study we investigated the 9 endobronchial
thoracic computed tomography evaluation there was a fistula between the           hamartoma cases, seen in our center between 1990-2000 by means of
pleura and fundus of the stomach. This fistula was clearly visualised on          clinical, radiological characteristics and diagnostic and therapy methods.
barium contrast graphy of the esophagus-stomach-duodenum (ESD). Oral              The mean age is 54.2 (39-66) in our cases. Male/female ratio is 7/2. 6 of
intake was stopped and a nasogastric tube was placed for decompression to         our patients smoked cigarettes (meanly 35 package-year). 3 of our cases
prevent chronic pleural irritation resulting from GPF. Parenteral nutrition       were asymptomatic. In the others the most seen complaint was cough (6-
was given during this time. Antibiotic treatment for empyema was started.         66%) and side pain (4-44%), dyspnea (3-33%), hemoptysis (2-22%) did

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

follow it. The tumor was on the left side in 5 (55%) and in these, 4 (44%)     PD-311 (TR)
on upper left lobe while 1 (11%), on left main bronchus and in 4 (45%)
on the right side, 3 (33%) on the right upper lobe, 1 (11%) right lower        EPIDEMIOLOGICAL FEATURES OF OUR PATIENTS WITH
lobe. In 7 (78%) of our cases hilar mass and in 2 (22%) parenchymal mass       LUNG CANCER
was seen. The mean diameter was 4.1 cm (between 3 and 6 cm) and in 1
case punctual calcification was seen. In all, we determined the                N. Alt›ntafl, A. Y›lmaz, A. Selvi, T. Karagöz
endobronchial lesion. The diagnosis was revealed by bronchoschopy in 5         SSK Süreyyapafla Center for Chest Diseases and Thoracic Surgery, ‹stanbul
(55%) and by thoracotomy in 4 (45%). Therapy was achieved in 4 (45%)
by bronchoschopical excission, in 1 (11%) by bronchotomy and excission,        The purpose of this study was to evaluate epidemiological features of our
in 3 (33%) by lobectomy and in 1 (11%) by pneumonectomy.                       patients with primary lung cancer. The present study included 790 cases
                                                                               diagnosed between January 2000 and August 2000 in our center. 684
                                                                               (86.6%) patients were male and 106 (13.4%) patients were female. The
PD-309                                                                         mean age of patients was 59.5 years. The male/female ratio was 6.45: 1.
                                                                               50.9 percent of the men was diagnosed after the age of 60 years versus only
DIAGNOSIS, STAGING AND TREATMENT OF LUNG                                       38.7% of women (p=0.025). Women were significantly more likely to be
CANCER IN YOUNGER AGE GROUP                                                    lifetime nonsmokers (65.1% versus 6.7%). Epidermoid carcinoma was the
                                                                               most common (47.8%) tumour type. While the ratio of epidermoid
H. Zutic, Z. Dizdarevic, B. Mehic, V. Cukic, B. Paralija                       carcinoma was 51.6% in men and 23.5% in women, the ratio of
University Clinic for Lung Disease Sarajevo, Bosnia-Herzegovina                adenocarcinoma was 33.5% and 55.7%, respectively (p<0.0001). Thirty-
                                                                               two (4.1%) patients had a positive family history of malignancy. Chronic
The aim of study was to estimate some characteristics in diagnostic, staging   obstructive pulmonary disease, tuberculosis and pneumoconiosis were the
and treatment of lung cancer (LC) in younger patients. Material and            most common respiratory system diseases. Twenty-nine patients (3.7%)
Methods: We analysed diagnostic tools, staging and treatment options of        had asbestos exposure. 86.8% of female patients were house-wife. Farmers,
LC in two groups hospitalised patients: Group I - younger patients - I (N=     builders, and drivers were the most frequent occupations. 81.9% of the
40) in several years (1997-2000- N=35) and Group II – elder patients – II      patients were living in urban areas. Conclusion: 1. Epidermoid carcinoma
in 1998 (>40 –N=255). We compared results in these two groups. Results:        is the most common tumour type. 2. Smoking is the most important
The diagnostic tools for PH diagnosis of LC in both groups were similar:       etiological factor in lung cancer. 3. 4. There were several differences
Fiberbronchoscopy (FB) was the most important way for taking samples,          between male and female patients with primary lung cancer with respect
more frequent (I : II 66.67%: 57.2%), and needle biopsy too. Younger age       to age, smoking habitus, and distribution of tumor type.
group had no any complications of biopsies, elder had pneumothorax in
1.87%, and bleeding in 0.993%. Staging of NSCLC: Younger group had
more cases in stage IIIB (59.1: 23.0%). Staging of SCLC was similar.           PD-312 (TR)
Treatment options: surgery – I: II = 8.33: 10.8%; Chemotherapy alone
54.17: 23.00%, chemotherapy + radiation 25.0: 7.6% and symptomatic             METASTATIC LUNG TUMOUR (REVIEW OF 44 CASES)
therapy 32.8: 12.5%. Therapeutic response on chemotherapy: PR 41.0:
33.3%, without response – I: II=41.67: 33.3%. Discussion: We found             D. Kanmaz, G. Özkan, N. Bakan, A. Gür, E. P›r›ldar, G. Çamsar›
some various clinical characteristics in younger and elder age group of LC     Yedikule Chest Diseases and Thoracic Surgery Training and Research
patients and very small percent of LC in stages II and I in comparing with     Hospital, ‹stanbul
others. Conclusion : In younger age group FB was more frequent diagnostic
tool for PH sampling, without complications; a lot of younger patients were    Fourty-four patients with metastatic lung tumour were reviewed
in late stage (IIIB), and chemotherapy and radiation were more frequent        retrospectively to evaluate the primary origin and tumour spread. Fourteen
in younger group, and symptomatic in elder group.                              of them were women, 30 were men and the mean age was 51.
                                                                               Endobronchial metastasis was found in 3 patients, lympangitis
                                                                               carcinomatosa in 3 patients, pleural effusion in 2 patients, pleural effusion
                                                                               plus multipl metastatic nodules in 3 patients and multipl metastatic
PD-310 (TR)                                                                    nodules in the rest of the patients. Primary tumour site was in 10 (22.7%)
                                                                               patients the lung, in 9 (20.5%2) patients the gastrointestinal system, in 5
LUNG CANCER IN FOUR PATIENTS WITH                                              (11.4%) patients the breast, in 3 (6.8%) patients the kidney, in 3 (6.8%)
EXTRAPULMONARY CANCER: IS IT PRIMARY OR                                        patients osteosarcoma, in 2 patients (4.5%) pancreas, in 1 patient (2.3%)
METASTASIS?                                                                    the tongue, in 1 patient (2.3%) the soft tissue, in 2 patients (4.5%) the
                                                                               genital system, in 1 patient (2.3%) the skin, in 1 patient (2.3%) the
F. Özfleker, S. Bilgin, A. Baran, I. Dilek, Ü. Bayram, E. Akkaya                bladder, in 1 patient (2.3%) the joint. Despite further diagnostic
SSK Süreyyapafla Center for Chest Diseases, ‹stanbul                            examinations in 5 patients (11.4%) the primary site of the tumour couldn’t
                                                                               be determined. Diagnosis was obtained in 21 patients by transthoracic fine
Lung lesions can be primary cancer or metastasis in patients with              needle aspiration, in 7 patients by bronchoscopy, in 5 patients by pleural
extrapulmonary cancer. We reported that, four male cases with                  biopsy, in 2 patients by postmortem biopsy of the mass, in 1 patient by
extrapulmonary cancer had primary lung cancer. Two cases with operated         excision of a periferal lymph node, in 1 patient by biopsy of a
lip cancer, one with operated larynx cancer, one with operated renal cell      retroperitoneal mass and, in 7 patients by clinical and radiological
cancer were evaluated for pathological chest x-ray in our clinic. Two cases    findings. The lungs are one of the most common sites for the development
underwent fiberopticbronchocopy and two had transthoracal needle               of metastatic disease for many tumours. Therefore the possibility of
aspiration biopsy. Out of four, three patients were diagnosed as squomose      metastase should be considered in patients with lung tumour.
cell lung carcinoma. One patient with operated larynx cancer was
diagnosed as adenocell lung carcinoma. Two cases were operable, but only
one case with lip cancer accepted operation. All patients had
chemotherapy for lung cancer. In conclusion, the risk of primary lung
cancer in patient with extrapulmonary cancer should be considered.

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                             81
 POSTER DISCUSSION                                                        TURKISH THORACIC SOCIETY 5TH ANNUAL CONGRESS ABSTRACT BOOK

PD-313 (TR)                                                                        PD-315 (TR)

                                                                                   G. Ertu¤rul1, S. K›l›ç1, M. Böncü 1, A. Atay 2, H. Halilçolar2
N. Köseo¤lu, E. Silistreli, O. Itil, Ü. Aç›kel, Ö. Oto, A. Akkoçlu, A. Karg›,      1
                                                                                     ‹zmir Chest Diseases and Surgery Training Hospital, ‹zmir
R. Çetingöz, U. Y›lmaz, E. Osma, B. De¤irmenci                                       Department of Biochemistry of Atatürk Training Hospital, ‹zmir
Departments of Chest Diseases, Thoracic Surgery, Cardiovascular Surgery,
Pathology, Radiation Oncology, Medical Oncology, Radiology, Nuclear                We searched if CEA and PSA help in early diagnosis, determination of
Medicine, Medical Faculty of Dokuz Eylül University, ‹zmir                         type and stage of lung cancer. Between April and October 2000, serum
                                                                                   CEA and PSA level measured in patients hospitalized in our services. 63
We analyzed retrospectively data available from 62 patients of 145 lung            of the patients had lung cancer, 21 of the patients had benign lung
cancer patients who had been operated between 1991 and 2001. 54 were               disorders. None of the patients have symptoms belong to prostate gland. In
men (87.1%) and 8 were women (12.9%). The mean age was 58.71 years;                lung cancer group, mean age was 62.4±7.9 (37-76), in control group, mean
58.93 years for men and 57.25 years for women. The histopathological               age was 58.8±10.7 (28-74) idi. 22 of the patients had squamous cell
results were squamous cell ca (34 cases-54.8%), adeno ca (22 cases, 35.5%)         carsinom, 18 of them had adenocarsinom, 14 of them had nonsmall cell
and mixed type (6 cases, 9.7%). The postop stages of the 6 cases evaluated         carsinom, 7 of them had small cell carsinom and 2 of them had indifferan
as stage IA preoperatively are; 2 as IA, 1 as IB, 2 as IIA and 1 as IIIA. The      carsinom. We concluded that in the cancer group, the mean of serum CEA
postop stages of the 20 cases evaluated preoperatively as stage IB are; 9 as       level was 3.35 ng/ml and 3.8 ng/ml in control group. Serum PSA level was
IB, 6 as IIB, 3 as IIIA and 2 as IIIB. The postop stages of the 16 cases           3.0 ng/ml in cancer group and 0.8 ng/ml in control group. We found that
evaluated preoperatively as stage IIB are; 1 as IB, 8 as IIB, 5 as IIIA and 2      serum CEA level was high in 28% of squamous cell carsinom, 44% of
as IIIB. The postop stages of the 16 cases evaluated as stage IIIA                 adenocarsinom. And serum PSA level was high in 27% of squamous cell
preoperatively are; 2 as IIB and 14 as IIIA. The postop stages of the 6 cases      carsinom and 6% of adenocarsinom. There was no correlation between
evaluated as stage IA preoperatively are; 2 as IA,1 as IB, 2 as IIA and 1as        serum median CEA and PSA level and patient’s age, performans status,
IIIA. Preop stages of IIA (1 case), IIIB (2 cases) and IV (1 case) did not         histological type, stage, TNM status, origin and number of metastases,
change postoperatively. Preop and postop TNM stagings are compared and             radiological and broncoscopic findings. There was a significant relation
factors affecting stage changes are analyzed. Postop stage evaluations are 2       between age and serom CEA level and between cigarette smoking and
cases as IA (3.2%), 11 cases as IB (17.7%), 2 cases as IIA (3.2%), 16 cases        PSA level. In conclusion, more complicated studies shold be organised to
as IIB (25.8%), 24 cases as stage IIIA (38.7%), 6 cases as IIIB (9.7%) and         determine the relation between serom CEA and PSA levels and lung
1 case as IV (1.6%). 15 cases were applied right and 19 cases were applied         cancer.
left pneumonectomy and their mean survival durations are respectively 21
months (15-26) and 33 months (24-42) (p=0.0549). Mean survival
durations according to histopathology are; 28 months (21-35) for adeno             PD-316 (TR)
ca, 24 months (20–29) for squamous cell ca, 19 months (5–33) for mixed
type (p=0.206). Mean survival durations according to postop stages are; 27         THE DIAGNOSTIC VALUE OF MALONDIALDEHYDE LEVEL
months for IA, 26 months (19-33) for IB, 24 months for IIA, 32 (20-43)             IN PLEURAL EFFUSIONS
months for IIB, 24 months (19-30) for IIIA, 18 (8-28) months for IIIB and
3 months for IV (p=0.000).                                                         Ö. Günefl1, A. Erbaycu 1, A. Özsöz 1, M. Örmen 2, B. Önvural 2
                                                                                     ‹zmir Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and
PD-314 (TR)                                                                          Research Hospital, ‹zmir
                                                                                     Department of Biochemistry of Dokuz Eylül University, ‹zmir
DETERMINING THE BRAIN METASTASIS IN NON-SMALL                                      It is thought that various tumor marker and biochemical parameters may
CELL LUNG CANCER                                                                   help in differential diagnosis of malignant pleural effusions (PE) causing
                                                                                   difficulties in diagnosis. In this study, malondialdehyde (MDA) levels of
M. K›y›k, L. Erkan, C. Tigin, N. Mutlu, N. Ifl›k, H. Özyurt, S. Ç›kr›kç›o¤lu        pleural liquid and serum in 106 cases with PE and serum MDA levels in
Yedikule Chest Diseases and Thoracic Surgery Training and Research                 healthy 30 cases as a control group. Serum MDA level was 2.65±1.47
Hospital-‹stanbul                                                                  nmol/ml and pleura/serum MDA level was 0.76±0.32 nmol/ml in exudate
                                                                                   PE. Serum MDA level was 1.68±0.56 nmol/ml and pleura/serum MDA
It is known that the brain metastasis directly affects the treatments and          level was 1.24±0.48 nmol/ml in transudate PE. Serum MDA level in
prognosis of lung cancers. For this reason we have searched the importance         exudate group (p=0.03) and pleura/serum MDA level in transudate group
of computerized brain tomography (CT) in staging, which is one of the              (p=0.001) was significantly higher. There was no difference for pleural
methods used in the staging the illness before treatment. 94 prospective           liquid MDA level between two groups. There was not significant
cases having non-small cell lung cancer (NSCLC) have been included in              difference for serum MDA, pleural liquid MDA and pleura/serum MDA
this study. In all cases CT has been taken and the cerebral symptom (CS)           levels between groups of malignant and benign PE, tuberculous (TB) and
has been checked. 24 of the cases (25.5%) were stage I, 14 of them                 other than TB PE. It was found that; in transudate-exudate (p=0.006)
(14.9%) stage II, 22 of them (23.4%) stage III a and 34 of them (36.2%)            (p<0.001), malignant-benign (p<0.001) and TB-other than TB (p<0.001)
were advanced stages (IIIb and IV). In 87 of the cases (92.6%) there was           PE, serum MDA levels were significantly higher than control group. In our
no CS and in 7 of the cases (7.4%) there was CS. In 7 of the cases (7.4%)          study, There were not significant differences for pleura and serum MDA
we have found brain metastasis on CT. In 4 of the cases where we have              levels between smokers and non-smokers (p=0.7) (p=0.995). The specifity
found brain metastasis (4.2%) there was no CS, and in 3 of them (3.2%)             of measured PE MDA was 100% where the sensitivity was 2.3%. In
there was CS. 3 of the CS cases was of advanced stage, and 1 of them was           conclusion, higher serum MDA levels were found in cases with PE and also
of an early stage. As a result, it is thought that it would be necessary to take   this increase was found to be independent from smoking. Pleural fluid
the CT in advanced cases even if there is no CS, and in early stage cases          MDA level did not differ in all groups.
the utility of taking CT having no CS should be searched with studies
involving more cases.

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

PD-317 (TR)                                                                      clinic-pathological aspects or the most frequent mediastinal tumours.
                                                                                 Lymphangiomas are bening lesion characterized by proliferation of Iymph-
DELAYS IN DIAGNOSIS AND TREATMENT OF LUNG                                        vessels. Lymphangiomyomatosis charecterized by proliferation of
CANCER                                                                           lymphatics and smooth muscle. Vascular tumours (with blood vessels in
                                                                                 origin) are unusual in the thorax and represent 1% of all mediastinum
T. Özdemir1, N. Baflay 1, B. Berktafl 1, H. Lakadamyal›2, M. Berko¤lu2             tumours. Fibrochistic tumours include: Fibrosarcoma, malignant
  Chest Diseases and Thoracic Surgery, 2. Service, Atatürk Training and          fibrohistocitoma. Tumours of adipose tissue. Lipoms are rare primary
  Research Hospital, Ankara                                                      mediastinal tumors, rhabdomyomas are tumours of muscle in origin and are
  Chest Diseases and Thoracic Surgery, 8. Service, Atatürk Training and          unusual benign tumours. Tumors of sceletic tissues are osteogenic sarcoma
  Research Hospital, Ankara                                                      and condro-sarcoma. Other tumor is for instance fibromesotelioma located
                                                                                 enter in the mediastinum without pericardial connections.
Lung cancer is the most common cause of death due to cancer around the
world. Virtually, the only patients who achive long term survival are those
with resectable early-stage disease. Naturally there is concern that delay in    PD-320 (TR)
diagnosis and treatment allows tumour progression and thus reduces survival.
This study was conducted to quantify delay between presentation and              THE EFFECTIVENESS OF CISPLATIN/GEMSITABIN
definitive treatment and also assess the factors responsible for such a delay.   CHEMOTHERAPY REGIMEN IN NON-SMALL CELL LUNG
149 patients with lung cancer were included in the study: 131 men (87.9%)        CANCER
and 18 women (12.1%). 104 had non-small cell lung carcinoma and 45
small cell lung carcinoma. The observed average interval from first              I. Öztop1, D. Tekifl 1, T. Yavuzflen 1, U. Y›lmaz 1, O. Itil 2, R. Çetingöz3,
presentation to therapeutic proposal is 154.22 days. This is due to a long                        3
                                                                                 M. Alakavuklar, A. Akkoçlu3
delay from the first consultation to the chest physician (123.26 days). The        Department of Medical Oncology, Medical Faculty of Dokuz Eylül
interval between first doctor consultation to first radiographic examination       University, ‹zmir
and average interval from the first consultation to the chest physician we         Department of Chest Diseases, Medical Faculty of Dokuz Eylül University,
found significant difference between men and women (p <0.005). Women               ‹zmir
were delayed longer. In lower educational patient group we found significant       Department of Radiation Oncology, Medical Faculty of Dokuz Eylül
negative correlation (-0.176) between first presentation to therapeutic            University, ‹zmir
proposal (p=0.032). Also notable in our study, more doctor application
made more delay (p=0.0001) and dyspneic patients had a shorter delay             Aim: To evaluate the effectiveness of cisplatin/gemsitabin (PG)
(p=0.005). We did not find out any difference between patients’ social           chemotherapy regimen in the treatment of non-small cell lung cancer
security cards and diagnosis/treatment delay interval. Because of the            (NSCLC). Material and Method: The work-sheets of 27 patients with
evidence linking lung cancer fatality rates and early diagnosis we strongly      NSCLC given PG chemotherapy regimen in Dokuz Eylül University,
support educational programmes for smokers. Also, every effort should be         Medical Faculty, Department of Internal Medicine, Division of Medical
made to reduce delays at the various steps in the diagnostic examinations.       Oncology between 1999 and 2002 were reviewed retrospectively. Disease
                                                                                 characteristics such as histological type, stage, number of chemotherapy
                                                                                 cycle, reponse rate, response duration, toxicity, progression free survival
PD-318 (TR)                                                                      (PFS) and overall survival (OS) were determined. Results: In this study
                                                                                 which enrolled 27 non-resectable NSCLC patients, 24 patients were men
PARANEOPLASTIC SYNDROMES IN LUNG CANCER                                          while 3 were women. Age was between 35 and 71 years (mean age 59±14
                                                                                 years). Ten patients had stage III and 17 patients had stage IV disease.
M. Ünsal, D. Katar, B. fiengül                                                    Histological subtypes were squamous cell in 17 patients, adeno ca in 9
Department of Chest Diseases Ondokuz May›s University, Samsun                    patients and large cell in one patient. PG chemotherapy regimen was given
                                                                                 to the all patients as first line treatment and 104 cycles were administered.
Between the years 1997-2000, it was evaluated the paraneoplastic
                                                                                 All patients were re-evaluated after two cycles chemotherapy and in whom
syndromes that seen in 610 patients, with lung cancer. It was found in           response was obtained the treatment was continued by the same regimen
patients respectively; clubbing 92 (15%), thrombositosis 65 (10%),
                                                                                 for a total of 6 cycles. Complete response and partial response were seen in
hypercalcemia 25 (4%), migratuar thrombofhlebitis 5 (0.8%), leukocytosis
                                                                                 two (7%) and 17 patients (65%) respectively. Median PFS and median
2 (0.3%), gynecomastia 1 (0.1%), Cushing’s syndrome 1 (0.1).These
                                                                                 survival were 12.0 and 13.2 months in whole group. In patients with stage
results was dissucced in the light of literature.
                                                                                 III, median survival, 1-year survival and 2-year survival were 14 months,
                                                                                 57.1% and 14.3% respectively. In patients with stage IV, median survival,
PD-319                                                                           1-year survival and 2-year survival were 7.5 months, 50.0% and 0%
                                                                                 respectively. Grade III-IV hematological toxicity was seen in 4 patients
TUMORS OF THE MEDIASTINUM “20 YEARS’ EXPERIENCE”                                 (16%) and grade III nefrotoxicity was seen in one patient (4%).
1980-2000                                                                        Conclusion: PG regimen is an effective and tolerable regimen in the
                                                                                 treatment of non-resectable NSCLC.
L. Zhegu, A. Kalerija, A. Menzelxhiu, L. Karagjozi, A. Hatibi
Department of the Thoracic Surgery and Reanimation Service,
Lung Diseases Hospital, Tirana, Albania                                          PD-321 (TR)

The mediastinum is an area of great interest for surgeons, pneumotogist          DEPRESSION IN PATIENTS WITH LUNG CANCER:
and radiologist; and the site of origin of numerous pathological processes       PREVALENCE AND RISK FACTORS
in tile period time 1980-2000, a total number of 186 patients underwent
diagnostic surgical procedures and tumourectomy of the mediastinum.              N. Songür, G. Erenci, H. Karfl›gil, Ç. Özdilekcan, M. Dinç
Mesenchimal tumour of the mediastinum are unusual in thorax. We                  Ankara Cancer Research Hospital, Ankara
account 46 cases with mesenchimal tumours which are 24% of all cases.
Approximately half of this had lymphatic or vascular origin whereas others       Purpose: To evaluate depression rates in patients with inoperable lung
mesenchimal tumours are less frequent. We’ll discuss briefly only the basic      cancer and to identify risk factors associated with depression and to explore

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                               83

the effect of treatment on depression. Patients and Method: In this study,     preliminary results of our ongoing study, we may suggested that successful
79 patients with inoperable lung cancer were evaluated for functional          pleurodesis not influenced by pleural fluid pH, LDH, total protein,
status, malnutrition symptoms, smoking habits. The incidence of depression     albumin and glucose levels.
was also determined by using “Back Depression Inventory” before and after
theraphy. Results: The overall prevalance of depression before treatment
was 51.8% (41/79). After theraphy, depression scores were significantly        PD-323 (TR)
decreased in the patients with depression (p<0.001). The performans score,
symptoms severity, malnutrition and stage of tumour were significantly         ANALYSIS OF LUNG METASTASES IN PATIENTS WITH
different in the patients with depression comparing to those without           PRIMARY EXTREMITY SOFT-TISSUE AND OSTEOGENIC
depression (p<0.001). High depression scores were associated with poor         SARCOMA
performance, moderate and severe malnutrition, severe symptoms such as
cough, dyspnea, pain, tiredness and advanced tumour. In the patients with      N. Songür1, M. Dinç 1, Ç. Özdilekcan1, S. Eke 2, I. Pak 3, U. Ok 3
NSCLC (n=64) and SCLC (n=15) groups, pretreatment median depression             Departments of Chest Diseases, Cancer Research Hospital, Ankara
scores were 14.8±1.3 and 24.3±2.7 respectively. After theraphy, median           Departments of Orthopedics, Cancer Research Hospital, Ankara
depression scores were significantly decreased to 10.8±0.9 and 18.7±3.7          Departments of Pathology, Cancer Research Hospital, Ankara
respectively (p=0.001). Median depression score was higher in SCLS group
than that in NSCLS group in both before (p=0.003) and after (p= 0.011)         Purpose: To report the incidence, radiographical findings and the time
treatment. However, the difference was decreased at the end of therapy.        course for the appearance of pulmonary metastases from extremity soft-
The difference was thought to be due to an excess of poor performance          tissue (STS) and osteogenic sarcoma (OS). Patients and Method: The
(p=0.009) and dyspnea (p=0.0039) in the SCLC group. Conclusion:                presence of lung metastases were retrospectively evaluated in four-hundred
Depression is common and, is an important problem in patients with lung        patients with extremity sarcoma treated in our Hospital. Data on the grade
cancer. Especially patients with more severe symptoms, poor malnutrition       of sarcoma treated at initial presentation, the lenght of time for the
or functional limitation, are prone to depression. Histopathological type      detection of metastases were presented. Histological and radiographical
and stage of tumor are also important factors. Psychological screening         findings of lung metastases were analysed and discussed. Results: In our
should be made at the early stage of therapy. Appropriate intervention is      study, 95 of 400 patients (23.7%) were found to develop lung metastases.
essential part of palliative care.                                             Median time from presentation to detection of lung metastases of
                                                                               extremity sarcomas was 8.0±1.01 months (95% CI: 6.02-9.98). More than
                                                                               75% of patients developed lung metastases within 1 year after
PD-322 (TR)                                                                    presentation. As the grade of the disease increased, the metastase-free
                                                                               intervals were significantly shortened (p<0.001). Histologicaly, malignant
PLEURAL FLUID PH, LDH, TOTAL PROTEIN, ALBUMIN                                  fibrous histiocytoma (MFH) was the most common type of extremity
AND GLUCOSE LEVELS AS A PREDICTOR OF SUCCESSFUL                                sarcomas (33.7%), followed by liposarcomas (23.7%) and osteogenic
PLEURODESIS FOR PATIENTS WITH MALIGNANT                                        sarcoma (10.5%). In 54 of 90 patients (60%), the presence of solitary
PLEURAL EFFUSIONS                                                              (11/90) or multiple (43/90) nodular metastasis was the only radiological
                                                                               finding. Metastatic lung nodules varied greatly in their size.The
H. Y›ld›r›m, M. Metintafl1, S. Erginel1, S. Metintafl2, F. Alatafl 2,
                                                                               distribution of the metastatic nodules in the lung was not uniform, but
‹. Uçgun2, M. Kolsuz 3                                                         they were concentrated mainly on lower lobes as being subpleural or
  Department of Chest Diseases, Medical Faculty of Osmangazi University,       paranchymatous. In 36 of 90 patients (40%), parenchymal mass, pleural
  Eskiflehir                                                                    effusion, hilar lymphadenopathy and pneumothorax were found. In a
  Department of Public Health, Medical Facilty of Osmangazi University,        subgroup of 15 patients (15/36), parenchymal mass, pleural effusions and
  Eskiflehir                                                                    hilar lymphadenopathy were accompanied with multiple nodules.
  Deliklitafl Tuberculosis Dispensary, Eskiflehir                                Conclusion: Our results indicate that about one-fourth of the patients
                                                                               with extremity sarcoma develop lung metastases. The lung metastases
Pleurodesis is a common treatment modality for palliation of the patient       frequently occur within first year after presentation. In 60% of patients,
with malignant pleural effusions (MPE). The purpose of this study was to       although, the nodular formations (multiple or solitary) may appear as only
determine the relative contribution of pleural fluids pH, LDH, total           radiological sign of the lung metastases, in remaing 40% of patients, other
protein, albumin and glucose on successful pleurodesis for patient with        less defined radiological findings can be found.
MPE. Fifteen consecutive patients with biopsy-proven malignancy and
recurrent symptomatic malignant pleural effusions were eligible to
participate in this study. Five grams of talc mixed in 100 mL of normal        PD-324 (TR)
saline was administered via tube thoracostomy after complete drainage of
the pleural effusion in each patient. Pleural fluid was obtained for pH,       FACTORS INFLUENCING SURVIVAL IN RESECTED
LDH, total protein, albumin and glucose measurement before tube                SUPERIOR SULCUS TUMOURS
thoracostomy. Side effects were recorded during hospitalization. To assess
response all patients were examined with chest radiographs at third day        C. Kutlu1, A. Sayar 1, A. Demir1, M. Metin1, H. Ak›n1, S. Dinçer1,
(early) and 1 month (late response) after pleurodesis. Complete response       N. Solmazer2, M. Bedirhan2, A. Gürses 2
was observed in 10 (67%) patients, partial response in 5 (33%) patients. In      Yedikule Chest Diseases and Thoracic Surgery Centre, Department of
the 10 patients with a complete response, the mean pH level of pleural           Thoracic Surgery, ‹stanbul
fluids was 7.33±0.07 (7.25-7.48), LDH 922±469 U/L (237-1595), total              Yedikule Chest Diseases and Thoracic Surgery Centre, Department of
protein 5.3±0.8 (4.60-7.10) g/dl, albumin 3.23±0.5 (2.30-4.00) g/dl and          Anaesthesiology, ‹stanbul
glucose 75.3±44.7 (24-141) g/dl. However, in the 5 patients with partial
response, the mean pH level of pleural fluids was 7.26±0.06 (7.20-7.33),       Background and Objective: Treatment modalities of the superior sulcus
LDH 664±334 (237-1154) U/L, total protein 5.02±1.02 (3.80-6.50) g/dl,          tumours remain controversial. This study aims to investigate factors
albumin 2.88±0.51 (2.30-3.60) g/dl and glucose 57.6±35.7 (13-105) mg/dl.       influencing survival in surgically treated superior sulcus tumours. Material
There were no significant differences between the patients with complete       and Methods: Thirty-one cases of surgically treated superior sulcus
response and partial response for the assessed parameters. According to the    tumours between 1994 and 2001 were retrospectively reviewed in terms of

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

their demographic and clinical features, treatment modalities, and                seven criteria. CT findings differentiating malignant nesothelioma from
survival. Results : All patients were male with a mean age of 52±9 (range         metastatic pleural disease were identified. Findings for malignant
32-73). 12 (39%) patients underwent surgery following radiotherapy while          mesothelioma were as follows: 1) pleural plaque (sensitivity 15%,
remaining 19 (61%) were treated surgery alone. Lobectomy was performed            specificity 100%) 2) interlober fissure involvement (sensitivity 30%,
in 25 (81%) of cases, and wedge resection in 6 (19%). Histopathological           specificity 99% ) 3) pleural thickening greater than 1cm (sensitivity 60%,
examination of resected specimens revealed adenocarcinoma in 15 (49%),            specificity 75% ). Whereas, findings for metastatic pleural disease were ; 1)
squamous carcinoma in 14 (45%), and large cell carcinoma in 2 (6%).               lung parenchymal involvement (sensitivity 50%, specificity 100%), 2)
Pathological staging was IIb in 20, IIIa in 3, and IIIb in 8 cases. The           mediastinal shift (sensitivity 19% , specificity 100% ), 3) mediastinal and
morbidity and mortality rates were 29% and 10% respectively. Complete             hilar LAP (sensitivity 44% , specificity 90% ). We concluded that CT is
resection was possible in 11 of 12 (92%) cases who underwent surgery              helpful in the differential diagnosis of diffuse pleural diseases, particularly
following radiotherapy, whereas this was only 68% (13 of 19) in surgery           in malign from benign conditions and metastatic pleural disease from
alone group (p= 0.20). Overall median survival was 18.4 months, 2 and 4           malignant mesothelioma.
year survival rates were 40% and 15% respectively. Median survival was 22
months in preoperative radiotherapy group and 13 months in surgery alone          PD-327
group (p=0.22). Conclusion : Although both the chance of complete
resection and survival rate seem to be increased by preoperative                  EXERCISE PERFORMANCE AND OXYGEN UPTAKE
radiotherapy, these differences failed to reach statistical significance due to   EFFICIENCY SLOPE IN OBESE CHILDREN PERFORMING
limited number of cases in this study.                                            STANDARDIZED EXERCISE

                                                                                  B. Marinov1, S. Kostianev1, T. Turnovska2
PD-325 (TR)                                                                       1
                                                                                    Department of Pathophysiology, Medical University, Plovdiv, Bulgaria
                                                                                    Department of Hygiene and Ecology, Medical University, Plovdiv, Bulgaria
NON-SMALL CELL LUNG CANCER                                                        Oxygen uptake efficiency slope (OUES) is an index meant to provide an
                                                                                  objective measure of cardiopulmonary function at submaximal exercise
T. Göksel, G. Çok, S. Soyer, T. Aysan                                             (Baba et al., JACC, 1996, 28: 1567). Aim: To study the exercise
Department of Pulmonary Medicine, Medical Faculty of Ege University, ‹zmir        performance and the discriminative ability of OUES in obese children
                                                                                  performing standardised exercise. Material and Methods: Sixty children
The purpose of this study was to determine the activity of gemcitabine as         (age span 6-17 yrs) divided into two groups, matched by age, sex and
a second-line chemotherapy for non small cell lung cancer (NSCLC). To             height-thirty obese subjects (15 girls/15 boys; BMI = 27.4±4.5;
be eligible, patients had to have histological or pathologically proven           ideal body weight range=122-185%) and 30 controls (BMI=18.8±2.7 m.
NSCLC that has failed to respond to a first-line chemotherapy with a              kg-2) performed incremental treadmill exercise test. Perceived exertion
cisplatin-containing regimen, a Karnofsky performance status greater than         was assessed by means of CR-10 Borg scale. Results: The duration of the
60% and adequate renal, haematological and hepatic functions. Patients            exercise for the obese children was significantly shorter than controls
were treated by gemcitabine given i.v. at a dose of 1250 mg/m2 on days 1,         (p=0.010) but obese children have greater absolute values for oxygen
8 every 3 weeks. Response was assessed after two courses of therapy.              uptake (VO2 peak ml.min-1=1907±671 vs. 1495±562; p=0.013), which
Twenty-nine patients entered the study. Five partial responses were               adjusted for body mass decrease significantly (VO2/kg
observed (17.2%). We observed grade 3-4 granulocytopenia and grade 3-4            =29.2±3.8 vs. 33.6±3.5; p<0.001). OUES correlated strongly with VO2
leucopenia in two patients. Median survival and time to progression were          peak (r=0.91) ; oxygen pulse (r = 0.80), diffusion capacity (r=0.77) as well
32 (6-84) and 14 (3-56) weeks, respectively. We conclude that                     as with anthropometric variables – height (r=0.88), fat free mass (r=0.86),
gemcitabine is well tolerated and has a modest activity as a second-line          age (r=0.83). No significant differences were found, between the studied
chemotherapy for NSCLC.                                                           groups concerning OUES. Obese children rated perceived exertion
                                                                                  significantly higher than controls–Borg score=6.2±1.2 vs. 5.2±1.1;
                                                                                  p=0.001. Conclusion : The absolute metabolic cost of exercise and
PD-326 (TR)                                                                       perceived exertion are higher in the obesity group compared to the control
                                                                                  subjects. OUES is highly dependent on anthropometric variables, which
CT IN DIFFERENTIAL DIAGNOSIS OF DIFFUSE PLEURAL                                   impedes its interpretation as exercise index in children.

N. fiahin, G. Polat, U. Y›lmaz, G. Utkaner, E. Yaln›z                              PD-328
‹zmir Chest Diseases Hospital, ‹zmir
                                                                                  RESULTS OF LONG-TERM OBSERVATION OF CHILDREN
The CT appearences of benign and malign pleural diseases have been well           WITH DIFFERENT SEVERITY OF ASTHMA.
described. However, there have been limited number of literatures which
assessed features in the differential diagnosis of diffuse pleural disease.       I. Malysheva
Without knowledge of clinical or pathologic data, we reviewed CT                  Institute of Health insurance, Russia
findings in 146 consecutive patients with proved diffuse pleural disease. 59
of patients had malign, 87 of them had benign pleural disease. The patients       The objective of the present research is learning natural course and
included 95 women and 51 men, 15-76 years old. CT findings that were              outcomes of a children’s asthma of a different severity in young adult age.
helpful in distinguishing malignant from benign pleural disease were: 1)          Ninety two children with medical diagnoses of an asthma born between
pleural nodülarity, 2) rind, 3) bilateral pleural disease 4) mediastinal          1970-1975 were under our observation from birth till 24-30 years. Sixty five
pleural involvement 5) pleural thickening greater than 1 cm 6) hilar and          patients (70.7%) had a mild asthma in childhood, twenty five (27.2%) – a
mediastinal LAP 7) volume loss. The sensitivities were 37, 22, 33, 30, 35,        moderate asthma and two patients (2.1%) had a severe asthma. To the
35 and 27% respectively. The specificities were 96, 96, 88, 88, 87, 86 and        present time the outcomes of a mild children’s asthma are: twenty two
86% respectively. Fifty one of 59 malign cases (sensitivity 86%, specificity      patients (33.8%) have no the marked clinical signs of an asthma; thirty
52%) were identified correctly by the presence of one or more of these            eight patients (58.5%) have a mild asthma and five patients from this group

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                                  85

(7.7%) suffer from a moderate asthma at the age 24-30 years. The outcomes       asthma severity and to the level of increased nonspesific bronchial
of a moderate children’s asthma are: four patients (16%) have no symptoms       hyperresponsiveness. Lightly increassed nonspecific hyperresponsiveness
of an asthma; seven patient (28%) suffer from a mild asthma; thirteen           in mild asthmatics was 78%, strongly increased in all of the cases in group
patients (52%) have a moderate asthma and one patient have a severe             C, and in 33% in group B. Our results showed significant relationship
asthma. Two patients who had been suffering from a severe childhood             between asthma severity,intensity of skin prick test results, sputum
asthma have a moderate asthma at the present time. The result obtained          eosinophilia, the presence of allergic rhinitis and eczema and the level of
indicate that only 26 patients have no signs of an asthma in young adult life   bronchial hyperresponsiveness.
and most of them (84.6%) had a mild asthma in childhood. According to
our opinion these patients should be under long-term medical observation
as the allergic diseases (rhinitis, dermatitis) are marked among them much      PD-331
more often than among those who has the symptoms of asthma at the
present time (accordingly in 92.3% and 62.1%).                                  HAEMOPHILUS INFLUENZAE                 PNEUMONIA IN CHILDHOOD

                                                                                L. Stojanovska, D. Stankovic, O. Stefanovska, L. Nikolova, L. Marjanovic
PD-329                                                                          Institute for Respiratory Diseases in Children, Macedonia

COST OF MANAGEMENT OF CHILDREN’S ASTHMA IN                                      Haemophilus influenzae    infections have an ordinary place in respiratory
ST. PETERSBURG                                                                  pathology. In relation with Streptococcus pneumonia   infections they are the
                                                                                most frequent causes of bacterial pneumonia. Aim: Analyze of bacterial
I. Malysheva, E. Tsura, A. Markin                                               pneumonia caused of Haemophilus influenzae    from clinical, radiological and
Institute of Health Insurance, Russia                                           laboratory aspects. Material and Methods: in this study we reviewed 42
                                                                                histories of patients with confirmed Haemophilus influenzaeas an
The objective of the research was costing of diagnostics and treatment of       etiological agent in the period of a year (2001). Our patients were at the
an asthma for usage of the obtained data for the health planning and for        age of 3-16 yr., without previous low-respiratory infections. Results: Mean
resource allocation of public health of St. Petersburg. By the experts in the   age of patients was 6 yr. In 40 (95.2%) was noticed data of dry persistent
field of a children’s asthma were formed the lists of diagnostic services and   cough with approximately duration of 2 weeks. 25 patients (59.5%) were
services of treatment (according Global Initiative for Asthma                   with increased temperature and in three children we had data for
publications) provided to the child with asthma both in polyclinic and in       chemoptysis. Auscultatory finding was pneumonic in all of the patients.
a hospital. Then the cost of each of these services (measures) was counted.     Laboratory investigations: in a half number of patients was noticed
Cost is an average price of service provided and material used for this given   accelerated sedimentation rate and increased number of leycocytes. Chest
actual unit. Direct cost of ambulatory management of children’s asthma          x-ray showed increasing of parenchymal changes in relation to interstitial:
(per 1 child in year) is 15.8$ (diagnostics services-22.3%; treatment           62% of the patients were with parenchymal changes and 36.9% with
services-7.7%). Direct cost of diagnostics (61.8%) and treatment (38.2%)        interstitial changes and in 7.1% patients changes were interstitial-
of one inpatient is 157.6$. Taking into consideration rate admission (2.08      infiltrative. Therapy was applicated in the period of 7-14 days. It was
per 1000) and average length of stay (17.8 days) we have clarified that         consisted of Cephalosporines and Macrolides based on antibiogram.
direct cost of management of children’s asthma is 176.1$ (per 1 child in        Conclusion : Our aim in this study was to notice that there is increase of
year). Taking into account the prevalence (1.82%) and number of new                                                            .
                                                                                infections caused by Haemophilus influenzaeThey are manifested with
cases of children’s asthma (2.64 per 1000) we have evaluated the quantity       more difficult clinic picture and with more extensive radiological changes.
of financial resource needed for management of children’s asthma in St.         Nowadays, bad socio-economic conditions in our country could be one of
Petersburg.                                                                     the causes for increased number of patients with these infections.

PD-330                                                                          PD-332 (TR)

S. Kostadinova, M. Caparoska
Institute for Respiratory Diseases in Children, Kozle, Macedonia                R. Hamutçu1, S. Turan 2, T. Erdo¤an 3, F. Karakoç 3, B. Karada¤ 3,
                                                                                A. Bereket3, E. Da¤l› 3
The aim of the study was to find possible relationship between atopy,           1
                                                                                  Department of Pediatric Pulmonology, Marmara University Hospital, ‹stanbul
asthma and bronchial hyperresponsivenes in children. The study included           Department of Pediatric Endocrinology, Marmara University Hospital, ‹stanbul
132 children with persistent atopic asthma (78 male, mean age 9.7 years)          Department of Pediatrics, Marmara University Hospital, ‹stanbul
and a control group of 12 children without asthma. Each children was
investigated by means od questionnaire, skin pric tests, sputum                 Bronchiectasis is an important problem in pediatrics as the final common
eosinophilia,total eosinophil counts and histamin bronchial challenge test.     sequela of several different lower respiratory tract insults. Bone density has
Four groups were defined: Group A- with mild persistent asthma (n=84),          been extensively studied in children with cystic fibrosis (CF) and it is
Group B- with moderate persistent asthma (n=39), Group C -with severe           suggested that osteoporosis occurs in CF secondary to chronic use of
persistent asthma (n=9) and D-control group (n=12). The occurance of            systemic corticosteroids, chronic malnutrition, and poor clinical status.
allergic rhinitis and eczema was strongly related to the severity of the        Although children with non-CF bronchiectasis carry similar risk factors, it
disease, ranging from 7.8% and 12.4% in group A, to 54.2% and 67.3% in          is not known whether bone density is affected in these children. Recently,
the group C. Children with asthma had significantly higher total                speed of sound (SOS) measurement by quantitative ultrasonography along
eosinophil counts, that the group D, but there was no correlation between       the tubuler bones become a useful method for assessing bone strength, since
total eosinophil count and asthma severity. The sputum eosinophilia was         it is proportional to both bone density and structural properties. In this cross
in corelation with the asthma severity. Intensity of skin prick test results    sectional study, we measured the radial and tibial SOS in 32 children (17
was significantly higher in asthmatics then in group D and was related to       girls) with non-CF bronchiectasis in comparison to age, sex and pubertal

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

status matched healthy controls. Calcium intake was assessed by a 4 day         dependence of oxygen concentration used for resuscitation, they were
nutritional diary. Clinical status including pulmonary function tests and       divided in 3 groups: group 1 (n=12)-resuscitated with room air, group 2
steroid use were noted. Mean age was 12.5±4.6 year. Thirteen children with      (n=16)-resuscitated with 60% O2 and group 3 (n=10)-resuscitated with
non-CF bronchiectasis had osteopenia (tibia or radius z-score <-1.0) and 9      100% O2. The control group consisted of 55 healthy term neonates (Apgar
had osteoporosis (tibia or radius z-score <-2.0). Bone SOS measurements of      score 8-9). One hour after delivery FRO (chemiluminescence intensity),
tibia and z-scores were significantly lower in non-CF bronchiectasis            antioxidant activity (AA), antiradical activity and acid-base equality
children compared to controls (p values 0.04 and 0.02, respectively).           (ABE) were investigated. Our results indicated that in neonates born in
Calcium intake was not different between the two groups. Six children           asphyxia all indices had wider individual fluctuations. Chemiluminescence
(18%) had moderate to severe lung disease (FEV1<60% predicted).                 intensity in control group was 423.3±68.3 U/ml serum, in group 1-
Children with lower FEV1 also had lower tibial bone density (r=-0.540,          427.6±98.5, in group 2 - 327.6±131.7 and in group 3 - 646.7±104.9.
p=0.009). All except 2 children (94%) were receiving inhaled steroids and       Antioxidative activity was in control group 202.4±55.4 ml-1 serum, in
children who received higher cumulative steroid doses had lower radial          group 1 - 185.3±31.3, in group 2 - 184.6±37.1 and in group 3 - 160.3±35.5.
bone density (r =-0.515, p=0.02). We conclude that children with non-CF         In group 3 FRO exceeded the normal values, but AA was lower.
bronchiectasis has lower bone density compared to controls which may be         Alignment of indices describing FRO and AA (chemiluminescence/AA)
related to the severity of the disease and steroid use. We suggest that these   was equal to 4.0, while in control, 1. and 2. groups was equal to 2.1; 2.3;
children should also be closely monitored for osteoporosis.                     1.8. There was no difference in ABE. Adaptation of neonates was more
                                                                                favourable in 1. and 2. groups: disappearance of neurological symptoms and
                                                                                regression of periventricular cerebral edema to 3-4 days of life, while in 3.
PD-333 (TR)
                                                                                group these symptoms persisted up to the end of the first week.
                                                                                Conclusion : it is not reasonable to use 100% oxygen in resuscitation of
COMPARISON OF BRONCHODILATORS IN ACUTE                                          neonates, born in mild asphyxia, room air should be used.

B. Karada¤1, Ö. Ceran 2, G. Güven 3, E. Dursun 3, I. Özahi 3, F. Karakoç 3,     PD-335 (TR)
R. Hamutçu3, S. ‹nan 3, E. Da¤l› 3
  Marmara University, ‹stanbul                                                  RADIOLOGICAL AND MICROBIOLOGICAL EVALUATION
  Haydarpafla Numune Hospital, ‹stanbul                                          OF 296 PATIENTS WITH CYSTIC FIBROSIS
  Zeynep Kamil Hospital, ‹stanbul
                                                                                C. Elmas, M. Koyun, E. Yalç›n, D. Do¤ru, U. Özçelik, N. Kiper, A. Göçmen
The efficacy of bronchodilators remains to be still controversal in acute       Hacettepe University, Pediatrics Pulmonary Diseases Unit, Ankara
bronchiolitis. We investigated the effects of salbutamol and ipratropium
bromide among 69 infants hospitalized for moderate to severe bronchiolitis      Radiological and microbiological findings of 296 patients diagnosed as
at their first episode of wheezing. Patients were enrolled into the study       cystic fibrosis in Hacettepe University Ihsan Do¤ramac› Children’s
between December 1998 and March 2000. Median age of the infants was             Hospital were evaluated. Chest x-rays taken during the first admission
5 months (range, 1-11 months). Study group was randomly assigned to             revealed that 130 (43.92%) patients had overinflation, 81 (27.36%) had
nebulised salbutamol (S) (n=24) (2.5 mg, q4h), ipratropium bromide (I)          consolidation, 46 (15.54%) had atelectasis, 20 (6.76%) had peribronchial
(n=22) (0.25 mg, tid) or placebo (P) (n=23) (2.5 cc serum saline, q4h).         thickenning, 17 (5.74%) had bronchiectasis. Seventy-nine (26.69%) of
Oxygen saturation, clinical score (derived from respiratory rate, wheezing      the x-rays were normal. Forty-five cases also underwent chest computerized
score, accessory muscle score and clinical condition), heart rate and           tomography. The most common finding was hyperinflation and was
physical examination were recorded at baseline, 30 minutes, 8 hours after       present in 40 (88.88%) cases. Peribronchial thickenning seen in 39
admission and daily thereafter. All groups were similar in terms of age,        (86.67%), bronchiectasis in 26 (57.78%). Only three patients had
duration of illness and severity of the disease. Although the baseline          mediastinal, hilar or paratracheal lymphadenopathy. Congenital lobar
evaluations were similar in all groups, 30th minute clinical scores were        emphysema in one patient and cystic adenomatoid malformation in
better in S and I groups compared to P (p<0.05, p<0.05). S and I groups         another were also diagnosed. In deep nasopharyngeal and sputum cultures,
were also significantly better at 8th hour with lower clinical scores           the most common pathogen was S. aureus and isolated in 376 cultures of
(5.8±1.1 and 6.0±1.0 vs.7.4±1.2, p<0.01) and higher oxygen saturation           89 patients. S. aureus and P. aeruginosa colonizations were recorded in 18
rates (95.1±4.6 and 93.5±4.1 vs. 89.6±2.4%, p<0.01). Clinical scores,           and 19 patients, respectively. Delta F508 allel frequency was found to be
oxygen saturation and respiratory rates were significantly better in S group    44.74% in Pseudomonascolonized cases, whereas it was only 23.83% in all
after 24 hours from admission compared to groups I and P (p<0.05). After        296 CF patients. In 4 of the patients, allergic bronchopulmoner
24 hours, daily evaluations were similar in all groups. There were no side                 s
                                                                                Aspergillosi were diagnosed. Fifteen cultures revealed C. albicans and in 2
effects reported during hospitalization period. In that study group,            different cultures of one patient Rhizopuswas isolated. Tuberculin skin test
salbutamol and ipratropium were found to be more effective than placebo         was performed in 61 patients and 10 were found to be positive. Four
in the management of acute bronchiolitis.                                       patient were diagnosed as pulmonary tuberculosis. Eighteen patients
                                                                                underwent bronchoalveolar lavage (BAL) treatment during follow up, and
                                                                                broncholaryngomalacia were diagnosed in a patient. S. aureus were
                                                                                isolated in 6 of the BAL cultures, and P. aeruginosa in 2 of them.
AFTER RESUSCITATION WITH DIFFERENT OXYGEN                                       PD-336 (TR)
                                                                                EMPYEMA IN CHILDREN: CONSERVATIVE TREATMENT
M. Kosov, V. Prokopenko, T. Oparina, I. Evsyukova, A. Arutuinian                AND IMMUNOLOGICAL STATUS
D. O. Ott Research Institute of Obstetrics and Gynecology, Russia
                                                                                S. Uyan, F. Karakoç, R. Ersu, B. Karada¤, G. K›yan, E. Da¤l›
With the aim to assess the influence of different oxygen concentrations on      Marmara University, ‹stanbul
free-radical oxidation (FRO) and condition of antioxidant system 38
newborn infants, born in asphyxia (Apgar score 4-6) were investigated. In       Optimal treatment of empyema in childhood is still contraversial. In this

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                              87

study 25 children treated for empyema were presented. Children were            between sex, atopy and severity of symptoms. Methods: With Easy latex
evaluated prospectively. All patients received empirical intravenous           agglutination test viral infections were detected. Results: 25 children
antibiotic treatment including methicillin or vancomycin and                   between 1-3 years were considered in the autumn-winter season 2000 year.
aminoglycosides following the diagnosis. Eighty seven percent of children      All confirmed with viral infection: parainfluenzae 3 (12%), influenza 4
(n=21) required chest tube drainage. The responsible organism was              (16%), and most of all wheezing episodes were result of adenoviruses 17
identified in only five children (25%) which was thought to be related         (68%). 2/3 of the children were male, and 3/4 had atopic status (confirmed
with previous antibiotic usage. Fibrinolytic treatment was used for five       with constitution and eosinophilia in secretions). The severity of the
patients (25%) with incomplete clinical and radiological resolution. No        wheezeing atacs were hardest in adenoviral infections. Conclusions: 1.
children underwent thoracoscopy or open surgery. All children had a            Viral infections are frequent reasons for wheezing. 2. Boys are mostly
complete resolution in their chest x-ray in 36.7±11.6 (12-60) days.            affected. 3. Infections with adenovirusis are presented with severe degree
Following recovery all patients had immunological screening for                of wheezing. 4 .Atopy and viral infections are clearly connected. 5.
immunglobulins, IgG subclasses and neutrophil function. Underlying             Knowing the causative agens (virus) is most important for treatment and
immunological defect were identified in four patients which was thought        longterm prognosis.
to be an important predisposing factorfor empyema formation inthese
children. In conclusion optimal treatment of empyema thoracis depends
on its phase of development. Although recently alternative treatment           PD-339 (TR)
methods such as thoracoscopy or open surgery are commonly used in the
early phases of empyema, it is emphasized that before any invasive             SERUM AND BAL FLUID CYTOKINE LEVELS IN
approaches conservative treatment including antibiotic treatment and           UNILATERAL COMMUNITY ACQUIRED PNEUMONIA
chest tube drainage should be considered in childhood empyema. We also
suggest that all patients who present with empyema should be screened for      M. Kolsuz 1, S. Erginel2, Ö. Alatafl 3, M. Metintafl3, F. Alatafl 3, I. Uçgun 3,
immunological abnormalities.                                                   E. Harmanc›3
                                                                                 Tuberculosis Dispensary, Eskiflehir
                                                                                 Department of Chest Disease, Osmangazi University Medical Faculty,
PD-337 (TR)                                                                      Eskiflehir
                                                                                 Department of Biochemistry, Osmangazi University Medical Faculty,
ETIOLOGY AND PROGNOSIS FACTORS IN SEVERE                                         Eskiflehir
                                                                               We investigated the initial levels of proinflammatory cytokines in serum
A. Çelikhisar, H. Çelikhisar2, Ö. Uslu 2, S. Güçlü 2                           and bronchoalveolar lavage (BAL) fluid at presentation of community
  ‹zmir Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and        acquired pneumonia (CAP) in relation to clinical and laboratory indices
Research Hospital, ‹zmir                                                       of infection. We prospectively studied 28 consecutive patients with
  Eflrefpafla Tuberculosis Dispensary, ‹zmir                                     unilateral CAP. The pneumonia severity assessed according to systemic
                                                                               inflammatory response syndrome (SIRS) and acute physiology and chronic
The aim of the present study was to investigate the effect of some clinical,   health evaluation (APACHE II) II score. Tumor necrosis factor alpha
radiographical and laboratory indices on the outcome of severe                 (TNF-α), interleukin (IL) -1b, IL-6 and IL-8 concentrations were
community-acquired pneumonia (CAP). A total of 81 patients with severe         measured by ELISA in BAL fluid and in serum. The concentrations of IL1-
CAP (58 mail, 23 female, mean age 49±18.62) admitted in our respiratory        b and IL-6 in BAL fluid were significantly higher in the involved lung than
intensive care unit were enrolled in the study. The overall mortality rate     in noninvolved lung (p=0.008 and p=0.012, respectively) or in serum
was found as 55%. Pleural effusion was detected in chest x-ray of 6 patients   (p=0.002 and p=0.025, respectively). But there were no significant
(7.4%) and radiological multilobar involvement of pneumonia was found          differences in serum and BAL fluid levels of TNF-α and IL-8 levels. Serum
at 34 of 81 patients (42%). The responsible microorganism was isolated in      and BAL from involved lung IL-6 concentrations were higher in SIRS
29 patients (35.8%) and the leading pathogens were found to be                 group than nonSIRS group (p<0.05), whereas TNF-α, IL-1b and IL-8
                         a                            .
Streptococcus pneumoniaend Pseudomonas aeruginosa The most frequent            concentrations showed no difference between SIRS and nonSIRS. IL-6
underlying disease was COPD with 18 patients (22.22%) The death rate           levels of BAL fluid from the involved lung were significantly higher in the
was significantly associated with age more than 60 years, low blood            patients who had complications than those who did not (p=0.024). There
pressure, leukocyte counts, high creatinine levels, high BUN levels,           was no significant correlation between APACHE II score and the
hypoalbuminemia, low blood pH levels, high blood pCO2 levels,                  cytokines. Our results indicate that TNF-α and IL-8 acts both as local and
multilobar involvement, underlying disease and mechanical ventilation          systemic mediator of inflammatory response and IL-6 is the most important
requirement. In conclusion, despite the availability of adequate               cytokine to determine the severity of the disease.
antimicrobial agents severe CAP is still one of the important cause of
death. The initial treatment is often empirical, being supported by
knowledge of epidemiologic and clinical data.                                  PD-340 (TR)

                                                                               COMPARISION OF TREATMENT METHODS IN EMPYEMA
                                                                               D. Özol, S. Öktem Ay›k, E. Erdinç
WHEEZING EPISODES CAUSED BY VIRAL INFECTIONS                                   Department of Chest Diseases, Medical Faculty of Ege University, ‹zmir

E. Daskalova, N. Uzunovska, B. Manceva, T. Ilievska, K. Boskovska              The aim of this study was to assess the methods used in the treatment of
Institute for Respiratory Diseases in Children, Macedonia                      empyema and to determine the safety and efficacy of intrapleural
                                                                               streptokinase. The study was carried out on 107 patients (85 female,
Wheezing means high pitched whistling sounds of breathing out especialy        average age 47.9±17.1 years) hospitalized during 1996-2001. Pneumonia
in small children, often triggered by virusis. The aim of this study is to     and malignancy were the two most frequent accompanying diseases.
show that the infections of influenza, parainfluenza and adenovirusis are      Drainage with chest tube drainage (group 1) was used in 44 cases,
frequent reasons for wheezing episodes, and to show the connection             thoracenthesis (group 2) was performed in 44 cases and intrapleural

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

streptokinaze with drainage (group 3) was given in 19 cases. Mean              patients after cerebrovascular insult (CVI). We have performed a
hospitalization time of patients was 21.8±15.1, 14.8±10.07 and 20.2±13.6       retrospective analysis of 400 patients (211 male, 189 female) with stroke,
days in group 1, 2, 3 retrospectively. Hospitalization time was shorter in     confirmed with computed tomography (CT), average age 63, who
thoracenthesis group (p<0.05). Based on x-ray findings, the rate of pleural    developed pneumonia. The incidence of pneumonia was analyzed in 2
thickening was 32 (%72.7), 16 (%36.4) and 11 (%57.9) in group 1, 2, 3          different groups of patients, who were classified according of CT findings
respectively. The rate of pleural thickening was higher in chest tube          after stroke. First group-352 patients (88%), with involvement of a. carotis
drainage group (p<0.05). We observed no specific complication (bleeding        interna system. The second group- 48 patients (12%), with involvement of
or allergy) in the streptokinase treated group. Nine (8.4%) patients were      a. vertebrobasilaris system. Criteria for diagnosis of pneumonia were: new
died. Intrapleural streptokinaz treatment is a safe procedure but it did not   pneumonic infiltration seen on a chest roentgenogram, physical chest
affect the hospitalization time or pleural thickening when compared to         findings, and one or more of the following symptoms: temperature higher
chest tube drainage.                                                           then 37.5°C, dyspnea, cough. Pneumonia was found in 45 patients
                                                                               (12.78%) in the first group, 22 patients (45.83%) in the second group.
                                                                               Aspiration pneumonia was the mainly cause of pneumonia, 82%, and were
PD-341 (TR)                                                                    developed due to post CVI swallowing disorders. 18% of the patients
                                                                               developed nosocomial pneumonia. Patients with stroke when a system of
DIFFERENCES BETWEEN GRAM-POSITIVE AND GRAM-                                    a. vertebrobasilarisis affected should be subjected to develop pneumonia
NEGATIVE SEPSIS IN COAGULATION ABNORMALITIES                                   (p<0.05) owing to frequent aspiration. Early recognition of the swallowing
DURING VENTILATOR ASSOCIATED PNEUMONIA                                         disorders could reduce the incidence of pneumonia after stroke.

G. Gürsel1, C. K›r›flo¤lu1, M. Dizbay 2, D. Arman 2
 Department of Respiratory Diseases, Medical Faculty of Gazi University,       PD-343
  Department of Infectious Diseases, Medical Faculty of Gazi University,       BACTERIAL COLONIZATION OF AIRWAYS IN PATIENTS
  Ankara                                                                       FOR THORACIC SURGERY

Activation of the coagulation system is a key feature in the pathogenesis      M. Armand, P. Michael, B. Ilan
of septic shock. While traditionally viewed as a complication of gram-         Asaf Harofe Medical Center, Israel
negative microbial endotoxin coagulation abnormalities may also result
from the effects of toxins present in gram-positive bacteria. The aim of the   The rate of infectious complications after thoracic surgery is between 20-
study was to investigate if any differences exist in blood coagulation         30% in the literature. In order to understand, predict, and prevent
between gram-positive and gram-negative pneumonia and sepsis.                  postoperative pulmonary infections, sputum culture were performed in 100
Medhods: 87 ventilator associated pneumonia (VAP) and 36 septic                consecutive patients waiting for thoracic surgery. All the patients with
episode in 58 patients were evaluated. Platelet number, protrombin and         positive sputum culture received one to three doses of perioperative
partial thromboplastin time, fibrinogen, fibrin degradation product and D-     preventive antibiotics, based on the culture studies. 78% of patients with
Dimer were measured during VAP and sepsis. The levels of all variabels         pulmonary malignancies were found to be colonized along with
were compared between group I (Gram-negative) and group II (Gram-              microscopically purulent sputum. The most frequent species were
positive). Results: 20% (17) of VAPs caused by S aureus and 10 episodes                     ,                               ,              ,
                                                                               Pseudomonas multiresistent Pneumococcus Acinetobacter Haemophylus           ,
were associated with sepsis also. There were 70 gram-negative VAP and 26                                ,
                                                                               and gram positive cocci as well, as Candida species. This is in striking
septic episodes.Mean age of the patients was 69±16 and mean APACHE             contrast with patients going to surgery with benign disease, their airways
II was 18±6. There were no significant differences between coagulation         were found colonized less then 20%. Considerable drop in postoperative
parameters among gram-negative and gram-positive VAPs. But when                infectious complications was noted, 6 severe pneumonias occurred,
patients with gram-positive and gram negative sepsis were compared             however, all of them had positive preoperative sputum culture. Patients
platelets numbers were significantly lower in group II (119 090±62 415)        going to surgery with borderline pulmonary function test,were operated on
than group I (188 821±100 864) and PTT longer in Group II (46.4±30.8)          under guided antibiotic protocol, and were mostly uneventful. Upper and
than group I (34.9±14.3) (p<0.05). Conclusion : These results showed           lower airway infections were successfully treated by antibiotics, directed by
that, gram positive sepsis was associated with lower platelet numbers and      preoperative culture studies. Empyemas were caused by different strains of
longer PTT than gram-negative sepsis. Further studies are necessary which      bacteria. We propose that the airways of patients are colonized in high
show mechanisms of coagulation in gram-positive and gram negative              rates and preoperative sputum culture is a useful in predicting, and an
sepsis.                                                                        itinerary for prevention and treatment of infectious complications of
                                                                               thoracic surgery.



A. Arsovska1, A. Popovski1, Z. Arsovski2
 Clinic of Neurology, Macedonia
  Clinic of Pulmonology and Allergy, Macedonia

Purpose of our study was to evaluate the frequency of pneumonia in

TORAKS DERG‹S‹ VOL. 3, SUPPL. 1, APRIL 2002                                                                                                             89

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