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Öğe Assesment of palliative care in lung cancer in Turkey (ASPECT study)(EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2015) Bulbul, Yilmaz; Ozlu, Tevfik; Arinc, Sibel; Ozyurek, Berna A.; Gunbatar, Hulya; Senturk, Aysegul; Bahadir, Ayse; Ozcelik, Melike; Yilmaz, Ufuk; Akbay, Makbule Ozlem; Saglam, Leyla; Kilic, Talat; Kirkil, Gamze; Ozcelik, Neslihan; Tatar, Dursun; Baris, Serap Argun; Yavsan, Mehmet; Sen, Hatice Selimoglu; Berk, Serdar; Acat, Murat; Cakmak, Gulfidan; Yumuk, Perran Fulden; Intepe, Yavuz Selim; Toru, Umran; Ayik, Sibel O.; Basyigit, Ilknur; Ozkurt, Sibel; Mutlu, Levent Cem; Yasar, Zehra Asuk; Esme, Hidir; Erol, Muharrem; Oruc, Ozlem; Erdogan, Yurdanur; Asker, Selvi; Ulas, Arife; Erol, Serhat; Kerget, Bugra; Erbaycu, Ahmet Emin; Teke, Turgut; Besiroglu, Mehmet; Can, Huseyin; Talay, Fahrettin…Öğe The assessment of the malignant mesothelioma cases and environmental asbestos exposure in Sivas province, Turkey(SPRINGER, 2014) Berk, Serdar; Yalcin, Huseyin; Dogan, Omer Tamer; Epozturk, Kursat; Akkurt, Ibrahim; Seyfikli, ZehraOne of the most significant diseases related to environmental asbestos exposure is malignant mesothelioma (MM). Sivas province is located in the Central Anatolia where asbestos exposure is common. We aimed to study clinical, demographical and epidemiologic features of the patients with MM in Sivas, along with the history of asbestos exposure. In total, 219 patients with MM who were diagnosed in our hospital between 1993 and 2010 were retrospectively analyzed in terms of demographical and clinical features. Rock, soil and house plaster samples were taken from the habitats of those patients and were evaluated with optical microscopy and X-ray diffraction methods. The age of the patients ranged between 18 and 85 years. The male-to-female ratio was 1.4:1. Most of the patients confirmed an asbestos exposure history. The most frequent symptoms of the patients were chest pain (60 %) and dyspnea (50 %). The gap between the start of first symptoms and the diagnosis date was approximately 4 months in average. The plaster materials used in most of the houses were made up of mainly carbonate and silicate minerals and some chrysotile. Ophiolitic units contained fibrous minerals such as serpentine (clino + orthochrysotile) chiefly and pectolite, brucite, hydrotalcite and tremolite/actinolite in smaller amounts. MM is not primarily related to occupational asbestos exposure in our region, and hence, environmental asbestos exposure may be indicted. Yet, single or combined roles and/or interactions of other fibrous and non-fibrous minerals in the etiology of MM are not yet fully understood and remain to be investigated.Öğe Clinical characteristics, treatment and survival outcomes in malignant mesothelioma(EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2012) Berk, Serdar; Dogan, Omer Tamer; Kilickap, Saadettin; Epozturk, Kursat; Akkurt, Ibrahim; Seyfikli, Zehra…Öğe Clinical Characteristics, Treatment and Survival Outcomes in Malignant Mesothelioma: Eighteen Years' Experience in Turkey(ASIAN PACIFIC ORGANIZATION CANCER PREVENTION, 2012) Berk, Serdar; Dogan, Omer Tamer; Kilickap, Saadettin; Epozturk, Kursat; Akkurt, Ibrahim; Seyfikli, ZehraBackground: Malignant mesothelioma (MM) is an insidious tumor with poor prognosis, arising from mesothelial surfaces such as pleura, peritoneum and pericardium. We here aimed to evaluate the demographic, clinical, and radiological features of patients with MM followed in our center as well as their survival. Methods: The study included 228 patients (131 male, 97 female) who were followed up in our institution between 1993 and 2010 with the diagnosis of MM. Results: The mean age was 59.1 years in men and 58.7 years in women and the sex ratio was 1.4:1 in favor of males. Environmental asbestos exposure was present in 86% of the patients for a mean duration of 40 +/- 20 years (range: 3-70). Pleural effusion and thoracic/abdominal pain were the most common presenting signs and symptoms (70.2% and 57.8%, respectively). One hundred-thirteen (66%) patients were treated with platinum-based combination chemotherapy (PBCT) plus supportive care (SC) and 67 (34%) patients received SC alone. The median follow-up time was 10.0 months. The median overall survival was significantly improved with PBCT plus SC compared to SC alone (11.4 vs. 5.1 months; p=0.005). The 6, 12, 18, and 24-month survival rates were significantly improved with PBCT plus SC compared to SC alone (72%, 43%, 19%, and 2% vs. 49%, 31%, 11%, and 1%). Conclusion: The survival of patients with MM improved in patients treated with PBCT. The survival advantage continued 12- and 24-month after the initial time of combination chemotherapy.Öğe Comparing Two Different Clinical Scoring Systems for the Diagnosis of Pulmonary Thromboembolism(Aves, 2008) Berk, Serdar; Dogan, Omer Tamer; Ozsahin, Sefa Levent; Akkurt, IbrahimIntroduction: The most important stage while diagnosing the pulmonary thromboembolism is suspicion of the clinical findings, various clinical, radiological, laboratory investigations and clinical possibility methods that are used for diagnosing pulmonary thromboembolism. Two of these methods are the Wells and Geneva methods. The aim of this study is to compare the value of these two methods for diagnosing pulmonary thromboembolism. Material and Method: The study included 173 patients, 90 (52%) of whom were considered as having a pulmonary thromboembolism and were administered medical therapy, and 83 (48%) were not considered as pulmonary thromboembolism cases. Results: All the patients were evaluated according to the Wells and Geneva methods. In the patients considered as pulmonary thromboembolism cases according to the Wells method clinical possibility groups, the rates are calculated as 100%, 84%, and 1% in high, moderate and low risk groups respectively. According to the Geneva method clinical possibility groups, the rates are calculated as 72%, 53%, and 37% in high, moderate and low risk groups respectively. These two methods are statistically valuable (p<0.05) in making the diagnosis of pulmonary thromboembolism. The value of these two methods for diagnosing pulmonary thromboembolism, both clinical possibility scores and risk groups, are compared with the ROC curve. The area under the curve (AUC) for clinical possibility scores was calculated as 0.97 for Wells method and 0.60 for Geneva, and AUC for risk groups was calculated as 0.92 for Wells method and 0.60 for Geneva. Conclusion: In conclusion the Wells method calculation is more valuable for diagnosing pulmonary thromboembolism.Öğe Comparison of some characteristics of the tuberculosis patients of Sivas Tuberculosis Dispensary(Aves, 2008) Dogan, Omer Tamer; Berk, Serdar; Ozsahin, Sefa Levent; Cakmak, Evrim; Akkurt, IbrahimAim: Mass investigation for tuberculosis (TB) detection had been abandoned many years ago, however, contact tracing is still an important component of TB control. The aim of this study was to investigate the differences of the parameters age, sex, bacteriological status, and outcomes between two diagnostic methods (contact tracing, n=305 and passive method, n=6799). Material and methods: Data source was Sivas Tuberculosis Dispensary register. Results: Mean age was 19.5 +/- 0.93 in the contact cases and 34.4 +/- 0.21 in the passive method group (p<0.0001). Female ratio in the contact cases was 43%, whereas it was 53% in the passive method cases (p<0.001). Pulmonary TB ratio in the contact cases group was significantly higher than in the passive method cases group (92.5% versus 83%; p<0.001). The ratio of smear (+) reporting in the passive method cases group was 12.05% and in the contact cases group it was 15.41% (p < 0.001). M. tuberculosis culture (+) reporting in the passive method cases group was 15% and in the contact cases group it was 18% (p<0.001). Abandonment, transferred, death and treatment completion had reported 44%, 1.3%, 2.95%, 49% in the contact cases group and, 37.6%, 4%, 5.7%, 50% in the passive method cases group, respectively (p<0.011). Mean age was lower and female ratio was higher in contact cases group. Conclusion: PTB reported in contact cases is more than extra pulmonary TB reporting. Clinic-radiological diagnosis was much more reported in patients found by passive method than in contact cases. Relatively few death rates in contact cases appeared to be associated with their mild clinical conditions.Öğe Correlation of right ventricular dysfunction on acute pulmonary embolism with pulmonary artery computed tomography obstruction index ratio (PACTOIR) and comparison with echocardiography(SPRINGER, 2015) Varol, Kenan; Gumus, Cesur; Yucel, Hasan; Sezer, Ferhat; Seker, Emrah; Inci, Mehmet Fatih; Yucel, Selma; Kaya, Hakki; Berk, Serdar; Yilmaz, Mehmet BirhanThe aim of this study was to determine the pulmonary artery computed tomography obstruction index ratio (PACTOIR) in patients who have been diagnosed with acute pulmonary embolism (APE) with multi-slice computed tomography (MSCT) and to research the predetermination efficiency of right ventricular dysfunction (RVD) compared with echocardiography (ECHO). One hundred patients (50 males, 50 females), who had ECHO findings and were diagnosed with APE, were subsequently examined in this study. Patients who had RVD on ECHO, tricuspid regurgitation, and pulmonary hypertension parameters that were completely positive were accepted to have RVD. RVD was identified in 52 patients (52 %) on echocardiography. The PACTOIR value for patients with RVD were evaluated to be significantly higher than those without RVD (41 +/- A 17 vs 20 +/- A 12 %, p < 0.001). In the ROC analysis, the PACTOIR cut-off value was 37.5 %, the sensitivity value was 67.3 %, and specificity value was 93.7 % (AUC 0.839, 95 % CI 0.752-0.905). We determined that the patients with RVD and PACTOIR values over 37.5 % can be recognized with a 92.1 % positive predictive value. Our conclusions indicated that the PACTOIR rate in RVD diagnosis in patients with APE can recognize the patients with and without RVD.Öğe Cumhuriyet Üniversitesi Tıp Fakültesi Hastanesi’nde Ocak 2000-Aralık 2003 tarihleri arasında pulmoner emboli ön tanısı ile izlenen olguların retrospektif değerlendirilmesi(Cumhuriyet Üniversitesi, 2005) Berk, Serdar; Gönlügür, UğurIV ÖZET Pulmoner emboli (PE) hastane ölümlerinin %15-20'sini oluşturur. Erken tanı ve uygun tedavi ile mortalite %30'lardan %10'lann altına inmektedir. Ancak klinik bulgu ve semptomların nonspesifik olması, tanıda halen altın standart olan pulmoner anjiyografinin her merkezde yapılamaması tam ve tedavide gecikmelere yol açmaktadır. Bu çalışmada amacımız; pulmoner emboli tanısı alan PE(+) ve ekarte edilen PE(-) olgulardaki ayırt edici klinik ve laboratuvar bulguları belirlemek, noninvaziv tanı yöntemlerinin etkinliğini saptamak ve ventilasyon/perfüzyon (V/P) sintigrafisi ile klinik skorlama sonuçlan arasındaki uyumu saptamaktı. Hastanemizde Ocak 2000 ile Aralık 2003 tarihleri arasında PE ön tanısıyla izlenen 270 hastanın retrospektif olarak dosya bilgilerine ulaşıldı. Klinik olasılık Hyers'in standart klinik skorlama modeline göre, sintigrafik olasılık Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) kriterlerine göre belirlendi. Pulmoner emboli tanısı V/P sintigrafisi, klinik olasılık ve diğer noninvaziv tanı testleri ile konuldu, 270 hastanın 121 'i PE(+), 149'u PE(-) olarak kabul edildi. Yaş ortalaması PE(+) grupta 52.7Ü7.4, PE(-) grupta 49.6±18.4 olup her iki grup arasında cinsiyet ve yaş yönünden anlamlı farklılık saptanmadı (p>0.05). Semptomlardan senkop, hemoptizi, bacaklarda şişme, fizik bulgulardan rai ve bacaklarda kızarıklık, risk faktörlerinden immobilizasyon ve derin ven trombozu (DVT), laboratuvar bulgularından international normalized ratio (INR), trombosit (PLT) sayısı, laktat dehidrogenaz (LDH) ve D-dimer yüksekliği ile hemoglobin (Hg) düşüklüğü, arter kan gazında bikarbonat (HCO3) düşüklüğü PE(+) grupta anlamlı olarak daha fazla saptandı (p<0.05). Ventilasyon / perfüzyon sintigrafisi ile klinik skorlama arasındaki uyum anlamlı bulundu (p<0.05). PE(-) hastalarda en sık pnömoni ve konjestif kalp yetmezliği/akciğer ödemi tanısı konduğu gözlendi. Sonuç olarak, D-dimer testinin PE tanısının dışlanmasında önemli olduğu, PE tanısı alan hastaların yaklaşık yansında nondiagnostik sintigrafik bulgulann saptandığı, bu grup hastalarda tanıda altın standart olan pulmoner anjiyografı yapılması gerektiği sonucuna varıldı. Anahtar kelimeler: Pulmoner emboli, derin ven trombozu, D-dimerÖğe Diagnostic usefulness of pregnancy-associated plasma protein-A in suspected pulmonary embolism(BIOMED CENTRAL LTD, 2013) Berk, Serdar; Dogan, Omer Tamer; Aydemir, Eylem Itir; Bingol, Asli; Ozsahin, Sefa Levent; Akkurt, IbrahimBackground: The role of biomarkers for prognostication and diagnosis of pulmonary embolism (PE) is increasing. It has been reported that pregnancy-associated plasma protein-A (PAPP-A) can be used as a proatherosclerotic marker. The present study was aimed to evaluate whether PAPP-A levels are helpful in the differential diagnosis of patients presenting with suspected PE. Methods: 53 consecutive patients evaluated for suspected PE were prospectively enrolled in the study. Serum PAPP-A levels were measured in the blood samples which were taken at admission. Multi-slice computed tomographic angiography was used to verify the diagnosis of PE. Results: PE was detected in 24 out of the 53 patients, while it was excluded in 29 patients by thorax multi-detector computerized tomography scan. No significant difference was detected in mean serum PAPP-A level between groups (5.72 +/- 0.31 mg/L vs. 5.67 +/- 0.06 mg/L, respectively). Conclusions: Serum PAPP-A level has no role in the evaluation for PE.Öğe Effects of long-term non-invasive home mechanical ventilation on chronic respiratory failure(TAYLOR & FRANCIS LTD, 2010) Dogan, Omer Tamer; Turkyilmaz, Suleyman; Berk, Serdar; Epozturk, Kursat; Akkurt, IbrahimObjective: Chronic respiratory failure (CRF) is a syndrome defined by certain disturbances in arterial blood gases. Non-invasive mechanical ventilation (NIMV) is an increasingly used treatment modality in respiratory failure. The aim of this study was to investigate the long-term effects of NIMV on pulmonary function and survival of patients with CRF. Methods: The study enrolled 170 CRF patients who it was decided should receive long-term home mechanical ventilation. Patients were stratified into two distinct groups - Group I (patients for whom NIMV was recommended and who had used it) and Group II (patients for whom NIMV was recommended at least 1 year ago but who had not used it for various reasons). Best arterial blood gas and pulmonary function test values in the year before the NIMV recommendation were obtained from patient records. The same tests were performed at least 1 year (1-5 years) after initiation of NIMV therapy in Group I patients and at least 1 year (1-5 years) after prescription of the device in Group II. Results: In the assessments performed 1 year after NIMV recommendation, no difference was found between groups in terms of hospital admissions. However, in Group I, intra-group analysis showed a reduction in the number of hospitalizations 1 year after NIMV. A marked reduction in PaCO2 level was found in Group I patients 1 year after NIMV therapy. Mean survival after NIMV recommendation was 40.27 +/- 3.56 months in Group I, and 27.35 +/- 3.68 months in Group II (log rank = 7.79; p = 0.005). It was found that survival time increased as duration of NIMV usage increased. Conclusion: NIMV therapy has some important and significant benefits in patients with hypercapnic chronic respiratory failure. This study has some limitations in terms of patient selection, power analysis and survival analysis. To assess the effects of NIMV on mortality and pulmonary functions, the authors believe that there is need for prospective, controlled, multicentre studies with longer follow-up periods, improved adherence and novel ventilator modes and settings.Öğe The evaluation of the relationship between malignant mesothelioma and environmental asbestos exposure in Sivas(EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2012) Berk, Serdar; Yalcin, Huseyin; Epozturk, Kursat; Dogan, Omer Tamer; Seyfikli, Zehra; Akkurt, Ibrahim…Öğe A Frame-Shift Mutation in the SLC34A2 Gene in Three Patients with Pulmonary Alveolar Microlithiasis in an Inbred Family(JAPAN SOC INTERNAL MEDICINE, 2010) Dogan, Omer Tamer; Ozsahin, Sefa Levent; Gul, Eylem; Arslan, Sulhattin; Koksal, Binnur; Berk, Serdar; Ozdemir, Ozturk; Akkurt, IbrahimPulmonary alveolar microlithiasis (PAM) is a rare disease characterized by the presence of small calculi in the alveolar space. The SLC34A2 is thought to be responsible for the disease. We encountered three siblings of an inbred family who have PAM. We examined the family of the proband who was admitted with dyspnea on exertion and cough, and eventually was diagnosed with PAM. Genetic analysis revealed that both parents (a consanguineous marriage) of the proband were carriers with heterozygous mutation of SLC34A2 gene, and three of their children were diagnosed with PAM with homozygous mutation in the SLC34A2 gene. These findings suggest that impaired activity of the SLC34A2 gene may be responsible for familial PAM.Öğe The Frequency of Chronic Rhinosinusitis/Nasal Polyp in COPD and Its Effect on the Severity of COPD(TAYLOR & FRANCIS INC, 2011) Kelemence, Alper; Abadoglu, Oznur; Gumus, Cesur; Berk, Serdar; Epozturk, Kursat; Akkurt, IbrahimThis study aimed to investigate the effect of chronic rhinosinusitis/nasal polyposis on the severity of COPD and to find out whether the 'united airway disease' hypothesis is valid for COPD. The study enrolled 90 patients diagnosed and staged according to criteria of an international guideline for diagnosis and management of COPD. The patients in stages I and II were classified as Group 1 and the patients in stages III and IV as Group 2. All the patients were questioned about the presence of major and minor criteria of sinusitis, underwent paranasal sinus computed tomography (PNS-CT) scans, and answered a questionnaire based on a quality of life test for sinusitis (SNOT-20). Sinusitis was present in 48 (53%) patients according to criteria of major and minor symptoms, and in 58 (64%) patients according to Lund-Mackay scoring system of PNS-CT. There was no significant difference in CT score between Group 1 and Group 2 (2.3 +/- 0.5 vs. 2.1 +/- 0.4, p > 0.05). However, the frequency of minor symptoms was greater in Group 2. SNOT-20 score was significantly higher in Group 2 than in Group 1 (28.7 +/- 1.7 and 22.2 +/- 1.9, respectively, p = 0.014). A significant correlation was determined between Lund-Mackay and SNOT-20 scores. The presence of CRS should be assessed in COPD patients, especially in those with severe disease. Further research is needed to disclose possible common immunopathological mechanisms in the pathogeneses of COPD and CRS.Öğe General characteristics and therapeutic options in lung cancer in Turkey(EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2015) Ozlu, Tevfik; Bulbul, Yilmaz; Arinc, Sibel; Ozyurek, Berna A.; Gunbatar, Hulya; Senturk, Aysegul; Bahadir, Ayse; Ozcelik, Melike; Yilmaz, Ufuk; Akbay, Makbule Ozlem; Saglam, Leyla; Kilic, Talat; Kirkil, Gamze; Ozcelik, Neslihan; Tatar, Dursun; Baris, Serap Argun; Yavsan, Mehmet; Sen, Hatice Selimoglu; Berk, Serdar; Acat, Murat; Cakmak, Gulfidan; Yumuk, Perran Fulden; Intepe, Yavuz Selim; Toru, Umran; Ayik, Sibel O.; Basyigit, Ilknur; Ozkurt, Sibel; Mutlu, Levent Cem; Yasar, Zehra Asuk; Esme, Hidir; Erol, Muharrem; Oruc, Ozlem; Erdogan, Yurdanur; Asker, Selvi; Ulas, Arife; Erol, Serhat; Kerget, Bugra; Erbaycu, Ahmet Emin; Teke, Turgut; Besiroglu, Mehmet; Can, Huseyin; Talay, Fahrettin…Öğe Laryngeal Hirudiniasis as an Unusual Cause of Massive Hemoptysis(B C DECKER INC, 2011) Berk, Serdar; Uysal, Ismail Onder; Epozturk, Kursat; Altuntas, Emine Elif; Dogan, Omer Tamer; Akkurt, Ibrahim…Öğe A longitudinal study on lung disease in dental technicians: What has changed after seven years?(VERSITA, 2013) Dogan, Derya Ozdemir; Berk, Serdar; Gumus, Cesur; Ozdemir, Ali Kemal; Akkurt, IbrahimThe aim of this 7-year follow-up study was to determine respiratory changes in dental technicians. In our region, in the year 2005, 36 dental technicians were evaluated with a cross-sectional study on respiratory occupational diseases, and in 2012 we evaluated them again. Inclusion of information on respiratory symptoms and demographic features questionnaires was applied. Pulmonary function tests (PFT) were performed. Chest X-rays (CXR) were evaluated according to the ILO-2000 classification. For the comparisons of the technicians' findings in 2005 and 2012, data analyses were performed with the Wilcoxon test in addition to descriptive statistical procedures. In 2012, 19 out of the 36 technicians continued to work in the same place, so we were able to evaluate their findings. The prevalence of respiratory symptoms in dental technician was as follows: dyspnea 7 (37%), cough 6 (32%), and phlegm 5 (26%). According to ILO classifications in 2005, among the 36 technicians, 5 (13.8%) had pneumoconiosis. At the end of 7 years, there were 9 pneumoconiosis cases among the 19 remaining technicians (47%). Thus, there was a statistically significant progression on the profusion of the radiologic findings (p < 0.005). Also there was a significant worsening on spirometric findings (p < 0.05). In dental technicians, a determination of both radiologic and functional progressions at the end of 7 years demonstrate that the primary and secondary preventive measures are necessary for these workplaces. Workplaces must be regularly controlled for worker health and hygiene.Öğe Performance of regional tuberculosis dispensaries in a province of Turkey in pre-DOTS era (1989-2002)(DRUNPP-SARAJEVO, 2010) Ozsahin, Sefa Levent; Arslan, Sulhattin; Dogan, Omer Tamer; Berk, Serdar; Akkurt, IbrahimBackground: In recent years, very few dispensary staff has been striving to apply directly observed therapy (DOT) elsewhere in Turkey, but the overwhelming majority of TB dispensaries still continue their usual practice today. Therefore, practice of any regional TB dispensary may mirror Turkey's Tuberculosis Programme practice profile. Method: Statistical Year Books of Sivas Province Health Department (from 1989 to 2002) are the main sources of data. The mid-year population numbers obtained from Statistical Year Books of Sivas Province Health Department were preferred for calculating annual incidences. Pearson's correlation coefficients and, if data ordinal, Spearman's correlation coefficients were used to determine correlations. Results: There are three TB dispensaries in the Sivas Province. Total staff number at Sivas TB dispensaries decreased within years (r = -0.92, p < 0.001). TB incidence declined within years, also(r = -0.87, p < 0.0001). Chest X-ray examinations gradually decreased within years from 20,416 examinations in 1989 to 5856 examinations in 2002 (r = -0.75, p = 0.002). Annual microscopic examinations for acid-fast bacilli (AFB) declined within years with 1400 microscopy done in 1989 decreased to 445 examinations in 2002 (r=-0.62, p=0.018). Per each TB patient, the annual mean microscopy for AFB examination was 4.49 +/- 1.47 and the mean chest radiography was 8.25 +/- 3.27 at local dispensaries in this fourteen-year period. The annual tuberculin skin test (TST) and Bacillus Calmette-Guerin (BCG) vaccinations per 100,000 population performed by local dispensaries did not statistically different within years (r = -0.45, p = 0.106 and, p = -0.15, p = 0.605, respectively). Conclusion: TB incidence declined within years, but this situation seems to be not related with improving of dispensaries performance.Öğe Pneumonia and Pleural Effusion Due to Brucella(EDICIONES DOYMA S A, 2012) Berk, Serdar; Engin, Aynur; Epozturk, Kursat…Öğe Prognostic importance of central thrombus in hemodynamically stable patients with pulmonary embolism(VIA MEDICA, 2017) Senturk, Aysegul; Ozsu, Savas; Duru, Serap; Cakir, Ebru; Ulasli, Sevinc Sarinc; Demirdogen, Ezgi; Kayhan, Servet; Guzel, Aygul; Yakar, Fatih; Berk, SerdarBackground: The association between mortality and localization of central thrombus in hemodynamically stable patients with pulmonary embolism (PE) is unclear. Sufficient data are not available to help clinicians to select between low molecular weight heparin (LMWH), unfractionated heparin (UFH) and thrombolytics for the management of central thrombus. The present study aims to investigate whether central thrombus in the pulmonary artery affects 30-day mortality rate, and to compare the outcomes of different treatment approaches in patients with central thrombus. Methods: This multi-central, prospective, observational study included 874 hemodynamically stable patients with PE confirmed by multidetector computed tomography scan. The localization of the emboli was evaluated and categorized as central (saddle or at least one main pulmonary artery), lobar or distal. The primary study outcome was 30-day all-cause mortality. Results: Localization of the emboli was central in 319 (36.5%) patients, lobar in 264 (30.2%) and distal in 291 (33.2%) patients. Seventy-four (8.5%) patients died during the 30-day follow-up period. All-cause mortality rate was 11.9%, 6.8% and 6.2% in patients with central, lobar, and distal emboli, respectively (p < 0.001). Multivariate analysis did not show that hemodynamically stable central thrombus was an independent predictor of mortality. Additionally, mortality rate was not significantly different between UFH, LMWH and thrombolytic therapy groups. Conclusions: The present study showed that central thrombus was not an independent predictor of mortality in hemodynamically stable PE patients. LMWH and UFH were similarly effective in the treatment of this patient group.Öğe Relationship between radiological (X-ray/HRCT), spirometric and clinical findings in dental technicians' pneumoconiosis(WILEY-BLACKWELL, 2016) Berk, Serdar; Dogan, Derya Ozdemir; Gumus, Cesur; Akkurt, IbrahimIntroductionPneumoconiosis in dental technicians' has rarely been evaluated. ObjectivesTo evaluate clinical, functional and radiological impacts of exposure to dust on respiratory functions via chest X-ray (CXR), high-resolution computed tomography (HRCT) and spirometry in dental technicians. MethodsDemographic data, respiratory symptoms, spirometry results, CXR and HRCT scans of 32 dental technicians were evaluated. The opacities on the radiological images were categorized based on their intensity. We investigated the relation of radiological scores with clinical, radiological and functional findings. ResultsThe mean age of the study population was 319 years and mean employment duration was 14 +/- 9 years. Twenty-two (69%) technicians had a history of smoking. The most common symptom was phlegm, while dyspnea prevalence was higher in those with an elevated International Labour Office (ILO) profusion score (P<0.01). Parenchymal opacities were determined in 10 (31%) technicians by CXR and in 22 (69%) technicians by HRCT (P<0.01). There was a positive correlation between ILO profusion score and HRCT score (r=0.765, P<0.01). ILO profusion score and HRCT score showed positive correlation with employment duration (r=0.599, P=0.01; r=0.514, P=0.01, respectively), while exhibiting negative correlation with FVC (r=-0.509, P<0.05; r=-0.627, P=0.01 respectively), FVC% (r=-0.449, P<0.05; r=-0.457, P<0.05, respectively) and forced expiratory volume in 1s (r=-0.473, P<0.05; r=-0.598, P=0.01, respectively). ConclusionsWe believe that a combined approach including spirometry, CXR and HRCT modalities should be employed in demonstrating respiratory disorders associated with exposure to inorganic dusts in dental technicians.
