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Öğe A Case of Massive Pulmonary Embolism Due to Diabetic Ketoacidosis and Hyperhomocysteinemia(Aves, 2014) Uzmezoglu, Bilge; Ozdemir, Levent; Hatipoglu, Osman Nuri; Ozdemir, Burcu; Edis, Ebru CakirA 57-year-old woman with no prior history was admitted to our emergency department with complaints of chest pain, dyspnea, xerostomia, syncope, and cyanosis on her lips and feet. On her physical examination, cyanosis, tachypnea, hypotension and sinus tachycardia were revealed. On the spiral computed tomography of the thorax of the patient with diabetic ketoacidosis, thrombus was detected in the left and right main pulmonary artery and segmental branches of the right pulmonary artery. The fibrinolytic treatment was initiated in the emergency department for the patient with hemodynamic shock due to the diagnosis of acute massive pulmonary embolism. Etiological examinations revealed B12 deficiency and hyperhomocysteinemia. This case, with the presentation of massive pulmonary embolism, resulted from the synergistic effect of hyperhomocysteinemia associated with B12 deficiency; hypovolemia caused by diabetic ketoacidosis was reported owing to its rareness.Öğe A case of ruptured hydatid cyst with upper lobe localization that imitated active lung tuberculosis(Aves Yayincilik, Ibrahim Kara, 2007) Ozlen, Burcu; Ozdemir, Levent; Yoruk, Yener; Altiay, Gundeniz; Tabakoglu, Erhan; Hatipoglu, Osman NuriHydatid cyst is a parasitic infestation caused by Echinococcus granulosus. Although liver is the most common site of infection, lungs may also be affected in 10 to 30 % of cases. The cyst is usually located in the lower lobes. of the lungs. A 49-year-old male patient with a cavitary lesion in the posterior segment of the right upper lobe, was admitted to the tuberculosis ward with a preliminary diagnosis of lung tuberculosis (TB), and anti-TB treatment was started empirically. Bronchoscopy was performed after three different sputum examinations with negative results for acid-fast bacilli (AFB). Bronchoalveolar lavage examination was also negative for AFB. High resolution computed tomography showed findings of a ruptured hydatid cyst, rather than TB. A cysctotomy was performed to the patient whose indirect hemagglutination test result was negative for hydatid cyst.Öğe A case of septic emboli secondary to osteomyelitis(Aves, 2006) Ozlen, Burcu; Cikmaz, Tuba; Ozdemir, Levent; Hatipoglu, Osman N.A 58 year-old woman was admitted to our emergency department with dyspnea, swelling and increased temperature of left leg. Since bilateral peripheral disseminated infiltrates on chest X-ray and severe hypoxemia in arterial blood gas were found, she was hospitalized with initial diagnosis of sepsis, Adult Respiratory Distress Syndrome, pulmonary embolism and vasculitis. Computed tomography revealed peripheral cavitary nodules in pulmonary paranchyme. Osteomyelitis was established in bone scan. Based on these findings the diagnosis was septic embolism secondary to osteomyelitis. Clinical and radiographic parameters were improved by empirical antibiotic therapy, noninvasive mechanical ventilation and other supportive care. Bilateral and peripheral infiltrates on chest x-ray; sub-pleural cavitary nodules on computed tomography and the presence of an extrapulmonary infection focus are significant clues that pneumonia may occur via hematogenous spread.Öğe The Change of Antituberculosis Drug Resistance Rate in Edirne Region in 1996 and 2006(Wolters Kluwer Medknow Publications, 2010) Perincek, Gokhan; Tabakoglu, Erhan; Otkun, Metin; Ozdemir, LeventObjective: To establish the change in the ratio of the a ntituherculosis drug resistance in Edirne region between 1996-2006. Materials and Methods: The patients, who were detected with Mycobacterium tuberculosis proliferation in the cultures, were enrolled to the study between 1996-2006. The patients, who were diagnosed with isoniazid, rifampisin, ethambutol, streptomycin and multi-drug resistance were selected and their data of was uploaded to SPSS software in order to perform statistical analysis. Results: We found the Mycobacterium tuberculosis proliferation of cultures in 70 patients in 1996, whew. 21 patients had isoniazid, 8 patients had rifampicin, 7 patients had ethambutol, r patients had streptomycin, and 5 patients had multi Burg resistance. En 2006, illyrobacterium tuberculosis proliferation was established in 47 patients. Of these, 11 patients had isoniazid, 8 had rifampisin, one patient had ethambutol, 2 patients had streptomycin and 3 patients had multi-durg resistance. We compared the changes in the resistance figures and found a decrease: of drug resistance as follows: in isoniazid, from 21 patients (301Y0) to 11 patients (23.4%); in rifampisin, from 8 patients (11%) to 4 patients (8.5%0; in ethambutol, from 7 patients (13'Yo) to one patient (2.1`,0; in streptomycin, from r patients (39%) to 2 patients (4.3%); in multi drug, from 5 patients (7%) to 3 patients (6.4`%). Conclusion: Although statistically significant decrease of drug resistance was not found in isoniazid, rifampisin, ethambutol and multi-drug, a significant drug resistance \vas estabished in streptomycin in Edirne region during the 10 years period.Öğe Churg-Strauss syndrome associated with montelukast(Turkish Assoc Tuberculosis & Thorax, 2008) Ozlen, Burcu; Ozdemir, Levent; Eskitutuncu, Banu; Cevirme, Leyla; Kurtar, Nazan; Soy, Mehmet; Hatipoglu, Osman NuriA 47 year old woman who had a history of asthma for 15 years referred to our hospital because of infiltrates on her chest radiograph that not responded to antibiotic treatment. We found that she had eosinophilia in peripheral blood (38%) and bronchoalveolar lavage (54%), nasal polyposis, and transient pulmonary infiltrates, and in the base of these findings we diagnosed as Churg-Strauss Syndrome (CSS). She has been using montelukast for 2 years. By examining her previous medical records, we observed that while eosinophil rates in peripheral blood were normal before montelukast usage, after this therapy eosinophil rates were greater 10 percent. Therefore, we thought that CSS was to be associated with montelukast usage. After just montelukast therapy was discontinued, clinical and radyographic parameters and the eosinophil counts (20%) improved. We present this case of CSS associated with montelukast in whom spontaneous remission was observed without using corticosteroids and cytotoxic agents.Öğe Cisplatin-Dependent Nephrotoxicity in Patients with Lung Cancer(Kare Publ, 2016) Ozdemir, Burcu; Ozdemir, Levent; Hatipoglu, Osman; Tabakoglu, Erhan; Altiay, GundenizOBJECTIVE The aim of the present study was to investigate nephrotoxicity development ratios and clinical results of nephrotoxicity in patients diagnosed with lung cancer who received cisplatin in chemotherapy protocol. METHODS A total of 170 lung cancer patients were enrolled in the present prospective study. Renal functions were recorded for each patient before and after chemotherapy. Nephrotoxicity was defined as doubling in plasma creatinine concentration. Modification in treatment due to nephrotoxicity (reduction in cisplatin dosage, cisplatin interruption, or discontinuation of chemotherapy) was recorded during chemotherapy courses. RESULTS Decreasement of creatinine clearance levels was observed following each course of chemotherapy, but was especially noteworthy following the 1st and 5th courses (p=0.002; p=0.007, respectively). Nephrotoxicity was observed in 19 of the 170 patients (11%), in 10 of whom (53%) cisplatin dosage was reduced, and in 8 of whom (42%), cisplatin treatment was interrupted. Chemotherapy was discontinued in 1 patient (5%). CONCLUSION Particularly following the fourth course, chemotherapy must be carefully administered due to risk of nephrotoxicity.Öğe Did unprogrammed tobacco control efforts over seven years decrease smoking prevalence in the medical school?(Turkish Assoc Tuberculosis & Thorax, 2011) Karlikaya, Celal; Ozdemir, LeventMedical students will have significant roles in combating against death tool of tobacco. The aim of this study is to evaluate whether any decrease in the smoking prevalence of the medical students over seven years of many tobacco control efforts. A self-administered questionnaire was carried out among 764 of 854 (89.4%) medical students in order to determine the knowledge, attitudes and behaviors towards tobacco use. Chi-square tests, Student's t-test and multiple logistic regression methods were used. Results were compared with the historical control study that was done seven years ago with same methods. 25.9% of the students were smoker (36.6% of males, 16.3% of females), 4.9% was exsmoker and 69.2% was nonsmoker. Quit rate was high among males than females (6.8% versus 3.3%, p<0.05). When compared with historical cohort in 1999, smoking rate decreased only 3.8% for males and 5.5% for females, and quit rates were not higher. Lower curriculum year, and lower knowledge level about the harms of smoking and environmental tobacco smoke in lower grades, living in bachelor homes, easy access to smuggled cigarettes, using non-cigarette tobacco products were main factors for smoking. There was little decline in smoking rates of medical students despite of many local and national tobacco control efforts over seven years. Special attention and organized, programmed efforts are needed in medical schools in Turkey.Öğe The Efficacy of Flutter® and Active Cycle of Breathing Techniques in Patients with Bronchiectasis: A Prospective, Randomized, Comparative Study(Bilimsel Tip Publishing House, 2018) Uzmezoglu, Bilge; Altiay, Gundeniz; Ozdemir, Levent; Tuna, Hakan; Sut, NecdetOBJECTIVES: The objective of the study was to compare the efficacy of an oscillating positive expiratory device and the active cycle of breathing techniques (ACBT) in patients with bronchiectasis. MATERIALS AND METHODS: A home-based study that lasted for 4 weeks was designed to compare the oscillating physiotherapy device Flutter (R) and the ACBT in 40 patients, who were randomly assigned into two groups containing 20 patients each. The effect of the two methods of physiotherapy on sputum production, pulmonary functions, and the quality of life was compared. RESULTS: The results of the present study indicate that both the methods were associated with a reduced number of patients complaining of cough and fatigue and increased sputum production (p=0.000, p=0.004, and p=0.002, respectively). In addition, statistically significant reductions were determined by the Medical Research Council and Borg Dyspnea scores (p=0.001 and 0.002, respectively). The Flutter (R) device caused a more significant effect on the perception of dyspnea. Overall, there was an improvement in the physical sub-scale of the Short Form (SF)-36 Quality of Life Questionnaire scores of 36 patients who completed the study (p=0.001). During the physiotherapy period, no changes in pulmonary functions were observed. Exacerbations were recorded in 3 patients in the ACBT group and in 1 patient in the Flutter (R) group. CONCLUSION: The Flutter (R) device and ACBT represent effective home-based physiotherapeutic methods. The Flutter (R) device appears to be more effective with regard to sputum production.Öğe Fat Embolism: Case Report(Aves, 2006) Ozdemir, Levent; Tabakoglu, Erhan; Gurlu, Vuslat; Hatipoglu, Osman Nuri; Altiay, Gundeniz; Yilmam, Ilker; Ozlen, BurcuFat embolism syndrome is a rare disorder which usually may be seen as a complication of long bone trauma. It becomes apparent 24-72 hours after injury with respiratory, neurological, urinary, ocular and cutaneous symptoms and sings. Our case is a 46 years old male patient who evaluated 30 hours after left tibia fracture for confusion, fever, dyspnea, tachypnea and a petechial rash on the anterior chest and anterior axillary folds. Chest radiograph was normal. The patient had hypoxemia and hypocapnia in arterial blood gases measurement. Ventilation perfusion scintigraphy revealed emboli with intermediate probability. No other etiology could be found to explain the state of confusion. Cotton-wool exudates and small haemorrhages were observed in retina. Many fat globules were found in urine samples. After steroid treatment, rapid clinical improvement was observed.Öğe Mortality Rates and Related Factors in Respiratory Intensive Care Unit Patients(Aves, 2007) Altiay, Gundeniz; Tabakoglu, Erhan; Ozdemir, Levent; Tokuc, Burcu; Cevirme, Leyla; Hatipoglu, Osman Nuri; Caglar, TuncayThe aim of this study is to identify the mortality rates and the influential factors in the respiratory intensive care unit (ICU). We prospectively evaluated a total of 150 patients consecutively admitted with respiratory failure between May 2003 and May 2005 in Trakya University Hospital, and 135 patients were enrolled in the study. The patients excluded from the study were the ones who died within the first 24 hours of ICU (n: 8), or had malignant diseases (n: 7). Chi-square test and t-test were used to compare hospital survivors with non-survivors, and logistic regression analysis was performed to define independent factors influencing the mortality rates in the hospital. To determine the efficiency of APACHE II, ROC analysis was used. 92 of the patients were male and 43 were female. The mean age was 64.9 +/- 12.9 years. The mortality rate was 32.6% (n: 44). The highest mortality rate was in patients with severe pneumonia/sepsis. (54.2%). The main conditions independently associated with increased mortality rate were arrhythmias (odds ratio [OR], 8.10; 95% confidence interval [CI], 2.67-24.58; p < 0.05), the need for invasive mechanical ventilation (OR, 6.04; 95% CI, 1.88 - 19.34; p < 0.05), the need for cardiotonic medication (OR: 5.36; % 95 CI: 1.67 - 17.22, p<0.05) and ventilator-associated pneumonia (OR: 5-21; 95% CI: 1.54-17.63; p < 0.05).Öğe Prognostic Factors Affecting Survival in Small Cell Lung Cancer Patients(Wolters Kluwer Medknow Publications, 2009) Ozlen, Burcu; Hatipoglu, Osman Nuri; Ozdemir, Levent; Sut, Necdet; Altiay, Gundeniz; Tabakoglu, ErhanAim: Small cell lung cancer (SCLC) is an aggressive tumour with a poor clinical course, but responsive to both chemotherapy and radiotherapy. Some clinical and laboratory parameters can predict survival in SCLC. The aim of this study was to analyze the survival and identify the prognostic factors that influence survival in SCLC. Material andMethod: Forty six consecutive SCLC patients who were planned for chemotherapy, enrolled in this study prospectively. We recorded basic characteristic properties and factors affecting prognosis for each patient. We determined their survival time and survival curves were calculated by the method of Kaplan and Meier analysis. Results: Median survival time was 338 days (95% confidence interval: 243-432). Survival ratio for one month was 89%, for 6 months 62% and for one year 45%. Significiant parameters (p< 0.05) evaluated by univariate analysis followed by multivariate analysis. In multivariate analysis liver metastas (Relative Risk (RR): 4.99, 95% confidence interval: 1,21 -20,53), weight loss (RR: 11.3, 95% confidence interval 1,11-115,5) and low level of total protein after first chemotherapy (RR: 0.198, 95% confidence interval 0,06-0,63) were found as independent factors affecting survival. Conclusion: SCLC is a disease with high mortality. Prognostic factors that we found, can be supported by further investigations.Öğe Pulmonary Nocardiosis Induced by Long-Term Use of Steroids on a Bronchiectasis Backgroung(Galenos Yayincilik, 2015) Ozdemir, Levent; Ozdemir, Burcu; Temelli, Mustafa; Hatipoglu, Osman NuriA 45-year-old male was assessed with the complaints of cough, sputum, fever, shortness of breath, tingling and burning in both legs. In his history, he had frequent hospitalizations and steroid use. Respiratory system examination revealed inspiratory and expiratory crackles on bilateral lower-middle zones and expiration rhoncus. Laboratory examination revealed leukocytosis and elevated CRP levels; serology for HIV was reported negative. Computed tomography showed diffuse interstitial pneumonia. Electromyography (EMG) showed lower extremity muscle activation compatible with myopathy. Acid-fast bacilli was negative (three consecutive negative microscopy results) and no reproduction was detected in the culture. Nocardia spp. growth was detected in sputum culture. According to the antibiogram results, he was treated with doxycycline, trimethoprim and sulfamethoxazole for 6 months. At the end of treatment, the lesions were found to be regressed on computed tomography. In conclusion, considering the high frequency of bronchiectasis in our country, the fact that nocardia may develop due to inappropriate long-term steroid use during an attack should be kept in mind.Öğe A Rare Cause of Hemoptysis(Aves, 2009) Ciftci, Abdullah; Ozdemir, Levent; Hatipoglu, Osman Nuri; Caglar, TuncayHemoptysis is a bleeding in the respiratory system together with a cough. Common causes of hemoptysis are bronchitis, lung cancer, bronchiectasis, pulmonary tuberculosis, pulmonary embolism and pneumonia. A 67-year old patient was diagnosed to have pepticulcus who was suffering from melana and hematemesis, and then hemoptysis developed while he was being treated in gastroenterology clinic. Because of this, we consultated him. In his case history, diabetes, hypertension, and a coronary bypass operation 3 years ago were available. In the chest radiograph, a homogenous and smooth-edged lesion sized 5x5 cm was observed on the periphery of the right lung. In the computerized tomography, lung fistulization and thrombosed fluid collection that is making pressure on the heart was observed on the right lung. The patient was operated in the cardiovascular surgery, and as a result of the rupture of the saphen graft that was placed during the bypass operation, right lung fistulization and hemoptysis developed. Thus, we found it appropriate to present this case as a rare cause of hemoptysis.Öğe Resistance Rates of Antituberculosis Drugs in Pulmonary Tuberculosis Patients Producing Mycobacterium Tuberculosis(Aves, 2011) Perincek, Gokhan; Tabakoglu, Erhan; Otkun, Metin; Ozdemir, Levent; Ozdemir, BurcuObjective: Determination of antituberculosis drug resistance rate in pulmonary tuberculosis patients producing Mycobacterium tuberculosis. Material and Method: 134 pulmonary tuberculosis patients producing Mycobacterium tuberculosis in cultures in the Trakya University Medical Faculty Hospital between the years 2005-2007 were enrolled in the study. Four major antituberculosis drugs (H, R, streptomycin (SM), ethambutol (EMB)) resistance and multidrug resistance rates were investigated. using the BACTEC 460 TB system. Results: 134 pulmonary tuberculosis patients producing Mycobacterium tuberculosis were detected and 31 female patients were found and 103 male patients. Acid resistant bacilli were found in 58.2% of the patients with EZN. Antituberculosis resistance rates were established as H 10.4%, R 3%, EMB 0.7%, SM 0.7%. Conclusion: It was determined that a follow up of drug resistance patterns in patients with pulmonary tuberculosis will be useful in determining treatment protocols and preventing drug resistance.Öğe Socioeconomic features and predisposing factors in patients with bronchiectasis(Aves Yayincilik, Ibrahim Kara, 2007) Ozdemir, Levent; Tabakoglu, Erhan; Hatipoglu, Osman Nuri; Altiay, Guendeniz; Ozlen, Burcu; Ciftci, Abdullah; Caglar, TuncayObjectives: The aim of this study was to determine socioeconomic features of cases with bronchiectasis and to determine predisposing factors which might play a role in the development of this condition. Patients and Methods: A total of 69 cases with bronchiectasis (43 males, 26 females; mean age 53.7 +/- 15.6 years) were retrospectively evaluated. Patients, totally in whom the was, predisposing factors for bronchiectasis, cigarette and alcohol consumptions, education and and monthly income levels were recorded. Results: Most of the cases multiple predisposing factors for bronchiectasis. Pneumonia (68%), measles (32%), and tuberculosis (18%) were the most common causes. Forty-two percent of the cases were primary school graduates and 20% never attended school. Fifty-five percent of the cases smoked cigarettes and 19% of the cases used alcohol. The mean monthly income was found to be 438.2 +/- 363 YTL. Conclusion: We concluded that bronchiectasis is prominent among individuals with low socioeconomic level.
