Attitudes of Pulmonologists about Obstructive Sleep Apnea Syndrome and its Treatment in Izmir

Objective We aimed to evaluate pulmonary medicine physicians’ attitudes about obstructive sleep apnea syndrome (OSAS) and its treatment in Izmir. Materials and Methods About 78 of 120 pulmonary medicine physicians in Izmir answered the questionnaire containing 24 items (demographics: 6, education: 4, attitudes: 9, knowledge: 5). Results 67.9% of the participants were female. Mean age was 41.06±5.63, mean working year was 11.16±6.09. 52.6% worked in training and research hospitals, 32.1% in state hospitals, and the rest in private and university hospitals. Monthly patient number was 714.10±3.24, patients number with OSA symptoms was 14.85±2.15. 64.1% had completed speciality education in hospitals with sleep disorders centers and this ratio was higher in physicians whose working year was less than 10. 24.4% had practiced sleep study during this education. Participation in sleep study courses after speciality education was 48.7%. 26.9% worked as sleep specialist. 67.9% usually asked patients OSA symptoms and 38.5% asked preoperative OSA symptoms. 97.4% usually referred patients to sleep centers. 65.4% had been working in hospitals with sleep disorders centers. The ratio of correct answers in knowledge part of the questionnaire was 95%. Conclusion OSAS is a major pulmonary disease and it is important in order to find out the patients with OSA risk. 2.07% of patients in clinics have OSA symptoms. Physicians’ confidence in diagnosis is more than managing patients with OSA. Practical part of sleep study is not enough in speciality education. Asking OSA symptoms is not common in pre-operative examination

A case of bilateral tuberculosis with a presenting symptom of massive haemoptysis

Akciğer tüberkülozu olan hastaların yaklaşık üçte birinde hastalıkları süresince hemoptizi ortaya çıkabilir. Diabetes Mellitus (DM) gibi altta yatan hastalığı olanlarda tüberküloz farklı radyolojik bulgularla seyredebilir. Bu raporda, radyolojik olarak sol akciğerde izlenen lezyonu olmasına rağmen sağ bronşiyal arterden hemorajisi olan 58 yaşında, DM tanılı erkek hastayı sunduk. Olgunun son 2 gündür devam eden tek seferde 1 su bardağı kadar kan tükürme yakınması vardı. Toraks bilgisayarlı tomografisinde (BT) sol üst lobda kısmen kitle formasyonu oluşturmuş konsolidasyon alanı mevcuttu. Bronkoskopide sağ ana bronşta hemoraji artığı, solda üst lobda pıhtı gözlendi, aspirasyon ile yoğun hemoraji gelişti ve sağ bronşiyal arterde kontrast madde ekstravazasyonu olması nedeniyle sağa bronşiyal arter embolizasyonu (BAE) yapıldı. Ancak, BAE sırasında izlenen bulguların radyolojik ve bronkoskopik bulgularla uyumlu olmaması nedeniyle, izlemde hastaya vasküler yapıların da değerlendirmesi amacıyla toraks BT anjiyografi uygulandı. Pulmoner arterlerde bir patoloji saptanmazken solda ve sağda asiner infiltrasyonlar gözlendi. Aynı zamanda balgamının mikobakteriyolojik kültüründe de üreme oldu. Hemoptizili olgularda radyolojik, bronkoskopik ve anjiyografik bulgular her zaman birbiri ile uyumlu olmayabilir. Akciğer tüberkülozunda hemoptizi birçok farklı nedenle ortaya çıkabilir ve çoğunlukla bronşiyal arterlerden kaynaklanır.Haemoptysis may be observed in one third of patients with pulmonary tuberculosis at any time during their disease. Tuberculosis may present with atypical radiological findings in patients with underlying diseases such as Diabetes Mellitus (DM). We presented a 58-year-old male with DM who haemorrhaged from the right bronchial artery although having a radiological lesion in the left lung. He had a glassful of haemoptysis in a single episode lasting two days. Chest computarized tomography (CT) showed a consolidation partially forming a massive lesion in the left upper lobe. Bronchoscopy revealed a haemorrhagic residue in the right main bronchus and a blood clot in the left upper lobe. After aspiration a major hemorrhage was observed and bronchial arterial embolization (BAE) was performed to the right bronchial artery where extravasion of the contrast agent was determined. However,in the follow-up, as the findings of BAE were not consistent with the bronchoscopic and radiological findings, a CT angiography was performed for the evaluation of the vascular structures. No vascular pathology was determined although there were acinary infiltrations in both lungs. Also, the mycobacterial culture of the sputum was positive. Radiological, bronchoscopic and angiographic findings may not always correlate in patients with haemoptysis. Heamoptysis may result from different causes in pulmonary tuberculosis and bronchial arterial system is usually the source

A lung cancer case with colon metastasis

Primer akciğer kanserinin semptomatik gastrointestinal sistem metastazına çok nadir rastlanılmaktadır. Burada başlangıçta kolon karsinomuna bağlı intestinal obstrüksiyon olarak değerlendirilen, ancak daha sonra akciğer kanseri kolon metastazı olduğu saptanan olgu sunulmaktadır.Symptomatic gastrointestinal tractus metastasis are very rare in lung cancer. We present here a case of lung cancer with colon metastasis which was evaluated as intestinal obstruction priorly