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Öğe Abant İzzet Baysal Üniversitesi Tıp Fakültesi çalışanlarında tüberküloz infeksiyon taraması(2001) Arbak, Peri; Akkoca, Öznur; Karacan, Özgür; Karakoca, Yalçın1998 yılının 6. ayında Tüberküloz infeksiyonu tarama programına alınan 112 sağlık çalışanının 75'i kadın (%67), 37'si erkek (%33) idi. Yaş ortalaması 27.2 ± 6.3 (18-48) idi. Yüzoniki çalışanın ilk tüberkülin testi değeri ortalaması 13.6 ± 6.9 mm (0-26 mm) bulundu. İlk tüberkülin testi değerleri ile BCG skar sayısı ve meslek grupları arasında anlamlı bir ilişki yoktu (p> 0.05). Çalışanların çalıştığı bölümler ile ilk tüberkülin testi değerleri arasında anlamlı bir ilişki bulundu (p= 0.02). Göğüs hastalıkları bölümünde çalışanlarda tüberkülin testi ortalamaları daha yüksekti. Altı ay sonra tüberkülin testi tekrarlanan 56 çalışanın tüberkülin testi değeri ortalaması 12.4 ± 8.4 (0-25 mm) bulundu. Altı aylık konversiyon hızı %1.8 idi. Sonuç olarak, Tıp Fakültemizde 6 aylık tüberkülin testi konversiyon hızının literatürde belirtilen Tbc infeksiyonu riski yüksek bulunan hastanelerin hızı ile uyumlu bulunduğu gözlendi. Hastanemizdeki sağlık çalışanlarının yılda en az bir kez tüberkülin testi ile izlenmesi gerektiği vurgulandı.Öğe Ankara'da çalışan hekimlerin toplum kökenli pnömonilerde tanı ve tedavi yaklaşımları(2000) Özşahin, S. L.; Karacan, Ö.; Arbak, Peri; Özdemir, Ö.Ankara merkezinde çalışan hekimlerin toplum kökenli pnömonide (TKP) tanı ve tedavi yaklaşımları anket yöntemi ile değerlendirildi. Toplam 328 hekimin 161'i (%49,1) pratisyen, 80'i (%24,4) uzman, 87'si araştırma görevlisiydi (%26,5). Kurumlara göre dağılım; tıp fakültesi hastanesi %26,4, çeşitli kurumlar %24,8, devlet hastaneleri %19,6, sağlık ocağı (SO) ve Ana Çocuk Sağlığı Polikliniği (AÇSAP) %17,4 ve diğer %11,8 şeklindeydi. Hekimlerin TKP'den şüphelendikleri hastalarda ideal laboratuvar koşullarında en sık istedikleri tetkikler sırası ile postero-anterior akciğer (PA AC) grafisi %95, lökosit sayımı %87, balgam gram boyama %77 idi. Tedavide tek antibiyotik kullananlar arasında en sık penisilin tercih edilmişti (%49,1). Bunu %32 ile makrolidler, %12,4 ile b-laktam/b-laktamaz inhibitörleri izliyordu. Kariyer ile hekimlerin antibiyotik seçimleri arasında fark yoktu. Branşlarına göre hekimlerin antibiyotik seçimleri karşılaştırıldığında pratisyen hekimlerin iç hastalıkları uzmanlarına oranla daha fazla penisilin tercih ettikleri görüldü (p=0,02). Tıp fakültesinde çalışan hekimler ise diğer meslekdaşlarına oranla daha fazla makrolid tercih etmekteydiler (p< 0.005). Hekimlerin %16,2'si ikili antibiyotik tercih etmişlerdi. Tedaviyi sonlandırma kriterlerinden en sık kullanılanlar ateş takibi %27,7, PA AC grafisi %13,7, fizik muayene (FM) bulguları %7,3 idi. Hastayı kontrol etme şansı olmayan hekimlerin %63'ü 10 günlük tedavi vermekteydiler. Çalışma grubundaki hekimlerin antibiyotik tercihleri Toraks Derneği Pnömoniler Tanı ve Tedavi Rehberi (TDPTTR) ile uyumlu bulundu.Öğe BCG aşılamasında neredeyiz?(2004) Yavuz, Taner; Arbak, Peri; Öztürk, Elif Cihadiye; Kocabay, KenanBCG aşısı tüberkülozdan korunma ve kontrol için yüksek riskli gelişmekte olan ülkelerde önerilmekte ve uygulanmaktadır. Türkiye'de 1997 yılından itibaren yeni "Bacillus Calmette-Guerin (BCG)" aşılama programına başlanmıştır. Çalışmadaki amacımız Düzce'deki BCG aşılama durumunu değerlendirmek ve aşılama programına etkili faktörleri analiz etmektir. Düzce merkez ve yedi ilçede bulunan toplam dokuz okul sekizinci sınıf öğrencilerinde BCG aşılılık oranına bakıldı. Aşı durumunu değerlendirmede BCG skar varlığı kriter olarak alındı. BCG aşılılık oranı %94 olarak bulundu. Öğrencilerin 1030'unda BCG skarı bulunmakla birlikte, 478'inde bir skar, 536'sında iki skar, 16'sında ise üç aşı skarı saptandı. BCG aşıldık oranı ile sağlık personeli başına düşen 15 yaş altı nüfus arasında anlamlı negatif korelasyon gözlendi. Ayrıca, BCG aşılama durumunun Türkiye'deki bölgesel farklılıkları da makalede tartışılmıştır.Öğe Clinical Characteristics of the Late Resolving Pneumonia Cases(Aves, 2005) Erbas, Mete; Annakkaya, Ali Nihat; Arbak, Peri; Balbay, Oner; Bilgin, Cahit; Bulut, IsmetIt has been well known that advanced age, cigarette smoking, presence of comorbid illnesses, multilobar radiographic involment, ongoing leukopenia, corticosteroid therapy are associated with late resolving pneumonia. We aimed to evaluate the effects of certain factors that were relatively less investigated such as gender, smoking, localization and pattern of radiographic involvement, the time of initiation of antibiotic therapy and antibiotic type on resolution of pneumonia. We retrospectively assessed the records and radiographs of 98 patients diagnosed as pneumonia. Mean age was 54 +/- 15 years, 52% of patients were female whereas 48% of them male. Delaying in resolution was detected in 17.3% of cases with pneumonia. Delaying in resolution of pneumonia was significantly higher in females (13/51) when compared to males (4/47). Delayed radiographic resolution was significantly more often observed in interstitial radiographic involvement than segmental and lobar involvement respectively. Mean initiation time of antibiotic therapy in patients with late resolving pneumonia was 14 +/- 6 days whereas 10 +/- 6 days with pneumonia that resolved in expected time (p<0.05). Most of the patients with normally resolving pneumonia were using single antibiotic (75/81) where all the patients in late resolving group were recieving single antibiotic. In conclusion, we decided some factors including gender initiation time of antibiotic treatment, radiografic involvement patterns have significant effects on resolutin of pneumonia.Öğe Effect of symptom-to-treatment interval on prognosis in lung cancer(Sage Publications Ltd, 2007) Annakkaya, Ali Nihat; Arbak, Peri; Balbay, Öner; Bilgin, Cahit; Erbaş, Mete; Bulut, İsmetAims and background: To evaluate the relationship between delayed diagnosis and the degree of invasion and survival in lung cancer. Methods: One hundred and three patients (96 men) with lung cancer were included. Stages in the diagnosis of lung cancer were classified as follows: symptom-to-doctor interval, i.e., the interval from the first symptoms related to the presence of lung cancer to the first consultation with a medical professional; doctor-to-diagnosis interval, i.e., the interval between the first medical visit and confirmation of the diagnosis; and diagnosis-to-treatment interval, i.e., the interval between diagnosis and complete TNM staging and treatment. The symptom-to-treatment interval (STI) was the sum of the 3 intervals. The degree of invasion was determined by the TNM classification. Results: The patients were followed up for a mean period ( SD) of 7.4 +/- 8.7 months. Seventy-six (74%) patients were diagnosed with non-small cell lung cancer (NSCLC) and 27 patients (26%) with small cell lung cancer (SCLC). The mean length of STI was 120 +/- 101 days (median, 90). The mean length of the symptom-to-doctor interval was 63 +/- 62 days (median, 45), while the doctor-to-diagnosis and diagnosis-totreatment intervals were 41 +/- 82 days (median, 10) and 16 +/- 12 days (median, 12), respectively. When the STIs of the patients were correlated with tumor stage, tumor invasion, lymph node involvement and metastasis, no significant differences were found. Patients with an STI longer than 60 days had a significantly longer survival. Regarding the type of lung cancer and STI, the median survival was shorter in patients with an STI of less than 60 days both in NSCLC and SCLC, although this was not statistically significant in SCLC. Conclusions: The shorter the diagnostic interval, the shorter was the median survival in our study. The reason for the apparent discrepancy between poor prognosis of lung cancer patients in spite of early diagnosis might be much faster progression of the disease itself.Öğe Effects of antithyroid medication on the flow-volume loop in patients with hyperthyroidism(2004) Arbak, Peri; Bicik, Zerrin; Şafak, Alper; Çınar, Yelda; Ülger, FüsunThis prospective study was designed to evaluate the effects of hyperthyroidism on flow-volume loops in nonasthmatic 20 patients with hyperthyroidism. Thyroid related hormones (Total T3, Total T4 and TSH), thyroid gland volumes with ultrasonography, circumference of neck values and flow-volume loops were obtained at the beginning and after three months of antithyroid treatment. Propylthiouracil treatment was followed by a statistically significant decrease in thyroid gland volume and circumference of neck (p < 0.001 and p < 0.001, respectively). The most significant result was improvement of maximum midexptratory flow rate (MMEFR) after propylthiouracil therapy for three months (p= 0.003). Increases in mean forced expiratory flow after 25% of FVC has been exhaled (FEF25), mean forced expiratory flow after 75% of FVC has been exhaled (FEF75) values were found consistent with the puerall improuement in expiratory flow parameters (p= 0.044, p= 0.072 respectively) in conclusion, we speculated that improvement of expiratory flow parameters might be the earlier changes in flow volume loops of patients who were treated with propylthiouracil for hyperthyroidism.Öğe Effects of iohexol on pulmonary functions in patients undergoing diagnostic coronary angiography(2004) Akdemir, Ramazan; Özhan, Hakan; Balbay, Öner; Erbaş, Mete; Gündüz, Hüseyin; Arbak, Peri; Yazıcı, Mehmet; Erbilen, Enver; Albayrak, Sinan; Annakkaya, Ali Nihat; Uyan, CihangirBackground: Adverse respiratory reactions have been reported with intravascular radiographic contrast media. The aim of the present study was to assess the effects of iohexol on pulmonary functions in patients undergoing diagnostic coronary angiography. Methods: Thirty patients diagnosed as coronary artery disease undergoing diagnostic coronary angiography were enrolled in the study. Subjects with chronic obstructive pulmonary disease, asthma, allergic bronchitis, myocardial infarction and documented systolic dysfunction by transthoracic echocardiography were excluded. The respiratory functions of the patients before and immediately after the coronary angiography were measured and arterial blood gas analyses were performed. The subjects were divided into two groups according to results of angiography as having coronary artery disease (Group 1) and without significant coronary artery disease (Group 2). The angiography procedures were performed by a single, experienced angiographer. Left Ventriculography was not performed on any patient Results: The results gathered before and after angiography procedure were compared. Forced expiratory volume in the first second (FEV1), maximum mid-expiratory flow rate, (MMFR) 25-75, arterial oxygen pressure (PaO2) and bicarbonate (HCO3) were significantly reduced ( p<0.01), where as forced vital capacity (FVC), pH, oxygen saturation and arterial carbondioxide pressure were not changed. The comparison between two groups resulted that FEV1 and PaO2 were significantly decreased after angiography in Group 1. Conclusions: Diagnostic coronary angiography using iohexol decreases ventilatory functions in a small but significant extent in patients without any overt pulmonary disease. Therefore they should be used cautiously in patients with chronic lung disease.Öğe Effects of iohexol on ventilatory functions in patients undergoing diagnostic coronary angiography(Springer, 2004) Özhan, Hakan; Akdemir, Ramazan; Balbay, Öner; Arbak, Peri; Erbaş, Mete; Gündüz, Hüseyin; Yazıcı, Mehmet; Erbilen, Enver; Uyan, CihangirBackground and objectives Adverse respiratory reactions have been reported with intravascular radiographic contrast media. The aim of the present study is to assess the effects of iohexol on pulmonary functions in patients undergoing diagnostic coronary angiography (CA). Materials and methods: 30 patients enrolled in the study. The respiratory functions of the patients were measured at three different stages during angiography (before, immediately after and 2 h later) and arterial blood gas analyses were performed at six stages during CA (before, immediately after the insertion of angiography catheter, 2 min after the injection of contrast agent, at the end of angiography, an hour and 2 h after angiography). A single, experienced angiographer performed the angiography procedures via radial artery route. Totally six multiple angled views of the left and right coronary arteries were recorded in all patients by hand injection. None of the patients were performed ventriculography. Results: Angiography caused significant reduction in forced expiratory volume in 1 sec [FEV1] (from 103 15 to 95 17, p < 0.01), forced vital capacity [FVC] (from 99 13 to 95 18, p < 0.05) and maximum mid-expiratory flow rate [MMF] (from 95 33 to 84 29, p < 0.01) whereas there were no significant changes in the mean FEV1/FVC ratios at different stages of angiography. Statistically significant decrease in PaO2 (from 91 10 to 85 13 mmHg, p < 0.01) and arterial O2 saturation (from 97 1% to 96 1%, p < 0.01) were also observed. Data in present study showed a clinically insignificant but statistically significant restrictive impairment in pulmonary functions. Conclusions: Diagnostic CA using iohexol decreases ventilatory functions in a small but significant extent in patients without any overt pulmonary disease.Öğe Effects of losartan on the renin-angiotensin-aldosterone system and erythrocytosis in patients with chronic obstructive pulmonary disease and systemic hypertension(Adis Int Ltd, 2001) Ülger, A. Füsun; Kumbasar, Özlem Özdemir; Karacan, Özgür; Arbak, Peri; Alper, DoğanayObjective: To evaluate the effects of losartan on blood pressure, erythrocytosis and the renin-angiotensin-aldosterone system (RAS) in patients with erythrocytosis and hypertensive chronic obstructive pulmonary disease (COPD). Design: Prospective, nonrandomised, two-period study. Patients and Participants: 24 patients were recruited, of whom 20 (17 men) completed the trial. The mean age was 55 +/- 8 years (range 40 to 65 years). Erythrocytosis was defined as a persistent elevation of the haematocrit to greater than or equal to 47% in females and greater than or equal to 50% in males. Patients were less than or equal to 65 years of age and hypertensive according to the WHO criteria. Patients who had hepatic and/or renal dysfunction, acute exacerbation of primary disease, were taking systemic corticosteroids, had any other systemic disease, or showed intolerance during the washout period were excluded. Methods: An initial 2-month period on, a standard regimen with nasal oxygen (2 L/min, 18 h/day) and bronchodilators (inhaled salbutamol, oral theophylline, inhaled ipratropium bromide) was followed by a second 2-month period during which losartan was administered as an antihypertensive agent in addition to standard therapy. Routine biochemical and haematological monitoring was carried out. Systolic and diastolic blood pressures (SBP and DBP respectively) were measured. ECG and arterial blood gas analyses were also performed for all patients at the beginning of the study, and all of these clinical and laboratory investigations were performed at 15-day intervals during the study. Plasma renin activity and serum aldosterone and erythropoietin levels were measured both at the beginning and at the end of each 2-month period. Results: No statistically significant changes were found in the measured parameters at the end of the 2-month standard treatment period. Fatigue and dizziness were reported by four of the patients during the first week of losartan treatment. Both SEP and DBP decreased by 10mm Hg with losartan treatment (p = 0.0003 and 0.0002, respectively). Haematocrit decreased from 53 +/- 3% to 48 +/- 4% (p = 0.0001). The mean arterial blood gas tension of CO2 (pCO(2)) was 54 +/- 11mm Hg and decreased to 48 +/- 4mm Hg (p = 0.01). Losartan treatment decreased serum aldosterone to 259 +/- 148 ng/dl from a mean baseline value of 156 +/- 140 ng/dl (p = 0.03). There were no statistically significant changes in pO(2) serum erythropoietin or plasma renin activity. Conclusion: Losartan controls blood pressure and reduces erythrocytosis in patients with hypertensive COPD, and is well tolerated. Although the mechanism of the effect of losartan on erythrocytosis requires further investigation, we propose that the RAS, in particular angiotensin II, has effects on the haemopoietic system and that blocking these effects decreases the haematocrit.Öğe Exercise capacity in sarcoidosis. study of 29 patients(Elsevier Espana Slu, 2005) Akkoca, Öznuc; Çelik, Gökhan; Ülger, Füsun; Arbak, Peri; Saryal, Sevgi; Karabıyıkoğlu, Gülseren; Alper, DoğanayBACKGROUND AND OBJECTIVE: Sarcoidosis is a systemic granulomatous disease of unknown etiology. Aims of this prospective study are to evaluate degree of impairment in pulmonary function tests (PFT), arterial blood gas analysis (ABG), respiratory muscle strength, exercise capacity and correlation of these parameters with radiological stages; to further evaluate the use of cardiopulmonary exercise testing in assessment of extent of pulmonary disease; and to discuss the pathophysiologic mechanisms of limitation in exercise capacity in patients with sarcoidosis. PATIENTS AND METHOD: 29 patients with sarcoidosis were grouped according to their radiological stages (stage I: group 1; stage II, group 2; stage III, group 3). Group 1, 2 and 3 included 11, 13 and 5 patients, respectively. PFT, cardiopulmonary exercise testing and ABG were performed for each patient. RESULTS: Evaluation of all patients showed a significant decrement in exercise capacity. Patients in stage III had decreased diffusing capacity and exercise capacity. There was limitation in exercise capacity in stage I patients who had completely normal spirometry and diffusing capacity. We also found a correlation between radiological stages of the disease and exercise capacity, diffusing capacity and ABG. CONCLUSIONS: Exercise capacity is impaired also in early stages of sarcoidosis and it was found to be the earliest impaired physiological parameter in sarcoid patients. Exercise intolerance, having mutifactorial basis, is correlated with radiological stages. Circulatory impairment and impaired heart rate response to exercise have effects on limitation in exercise capacity. Especially in advanced radiological stages of disease, ventilatory and gas exchange impairment also seems to be effective on limiting exercise in patients with sarcoidosis.Öğe Intima-media thickness of the common carotid artery in highway toll collectors(John Wiley & Sons Inc, 2006) Erdoğmuş, Beşir; Yazıcı, Burhan; Annakkaya, Ali Nihat; Bilgin, Cahit; Şafak, Alp Alper; Arbak, Peri; Tugay, AliPurpose. To assess the effects of exposure to exhaust particles on intima-media thickness of the common carotid artery in highway toll collectors, Methods. Sixty-one highway toll collectors (HTCs) between 24 and 56 years of age (mean, 36.2 +/- 7.3) and 48 controls between 24 and 64 years of age (mean, 42.6 +/- 10.6) were evaluated with gray-scale sonography to measure intima-media thickness (IMT) of the common carotid artery (CCA). Subgroups were categorized according to duration of exhaust exposure and further divided according to tobacco use. Results. CCA IMT was higher (0.8 +/- 0.2 mm) in HTCs than in the control group (0.6 +/- 0.1 mm; p < 0.001) and remained higher when subgroups with similar smoking habits were compared. In HTCs, IMT was greater when the number of years working in tollbooths was greater (p = 0.023). IMT was lower in HTCs with an exposure duration of < 10 years compared with a duration of 10-20years (p = 0.017) or > 20years (p value not significant). Conclusion. Air pollution has a widely acknowledged negative effect on humans. This study confirms that exposure to exhaust particles might cause wall thickening of carotid arteries.Öğe KOAH'lı istirahat koşullarında ekspiratuar akım hızları ve arter kan gazı değerlerinin egzersiz performansına etkisi(2002) Yazıcı, Mehmet; Arbak, Peri; Balbay, Öner; Maden, Emin; Erbaş, Mete; Erbilen, Enver; Albayrak, Sinan; Akdemir, Ramazan; Uyan, CihangirBu çalışmada KOAH'lılarda istirahat koşullarında ekspiratuar akım hızları ve kan gazı değerlerinin yürüme bandında efor testi parametreleri (treadmill exercise testing parametres: TETP) ile ilişkisi ve bunun hastalığın şiddetini öngörmedeki değeri araştırılmıştır. Bu çalışmaya 45 KOAH'lı hasta (kadın/erkek: 9/36, yaş ortalaması: 61±11yıl) ve 21 sağlıklı birey (kadın/erkek: 4/17, yaş ortalaması: 60±10 yıl) alındı. Tüm KOAH'lı hastalar (I. grup, FEV1 %51.3±7.2) FEV1 değerlerine göre 3 altgruba (II. grup/hafif KOAH, FEV1 %60-79, III. grup/orta düzeyde KOAH, FEV1 %40-59, IV. grup/ileri derecede KOAH, FEV1 < %40 ) ayrıldı. Kontrol grubunda FEV1 >%80 idi. Tüm gruplara istirahat koşullarında spirometri ile SFT ve sonrasında semptomla sınırlı maksimum efor testi uygulandı. Toplam koşu süresi (TKS), toplam metabolik eşdeğerleri (TMET), maksimum VO2 ( mVO2) düzeyleri ve maksimum kalp hızı (mKH), III. grup (mV02: 17.6±4.9; p<0.0001, TKS: 3.8±1.1; p<0.0001, TMET: 4.8±1.3, p<0.001, mKH: 127.9±17.3 p<0.01) ve IV. grupta (mVO2: 15.2±5.3, p<0.0001, TKS: 3.3±1.2, p<0.0001, TMET: 3.9±1.5, p<0.0001, mKH: 114.9±15.6, p<0.001) kontrollere (mVO2: 27.3±5.9, TKS: 7.1±1.3, TMET: 8.3±2.2, mKH: 137.3±13.4) göre anlamlı farklılık göstermekteydi. Ek olarak IV. grupta ventriküler erken atım sayısı (VEAS) kontrol grubuna göre anlamlı olarak artmıştı (2.9±1.4'e 1.7±1.1, p<0.01). Hafif KOAH grubunun tüm değerleri kontrol grubuna benzerdi. FEV1 ile TETP arasında III. grupta (mVO2: r=0.35/p<0.005, TKS: r=0.31/p<0.01, TMET: r=0.29/p<0.01) ve IV. grupta (mVO2: r=0.49/p<0.001, TKS: r=0.45/p<0.005, TMET: r=0.31/p<0.01, mKH: r=0.29/p<0.01, VEAS: r=0.27/p<0.05) anlamlı korelasyonlar saptandı. Ayrıca IV. grupta PaO22 değerleri ile TETP arasında da benzer bir ilişki (mVO2: r=0.43/p<0.005, TKS: r=0.35/p<0.01, TMET: r=0.32/p<0.02, mKH: r=0.31/p<0.03, VEAS: r=-0.29/p<0.05) bulundu. Bu çalışmada orta-ileri derecede KOAH'lılarda istirahat ekspiratuar akım hızları ve PaO2 değerleri ile efor testi parametreleri arasında yakın bir ilişki olduğu ve bu ilişkinin hastalığın ciddiyetini öngörmede önemli bir rolü olabileceği sonucuna vardık.Öğe Küçük hücreli akciğer kanseri olgusunda tümör lizis sendromu(Aves, 2005) Arbak, Peri; Bilgin, Cahit; Balbay, Öner; Bicik, ZerrinAs a result of large tumor burden, acute tumor lysis syndrome (TLS) is most often seen with lymphoproliferative disorders. An uncommon association of solid tumors and TLS also have been reported. We present a patient with metastatic lung carcinoma who developed TLS. A 58-year-old male was hospitalized for a mass in left lower lobe of lung and multiple low attenuation lesions in liver revealed by computed tomography. Liver biopsy specimen revealed metastatic small cell lung carcinoma. Cisplatin (60 mg/m(2), day1), Etoposide (120 mg/m(2), day 1,2,3) regimen was started. Biochemical parameters of the patient were in normal ranges before chemotherapy, one and two days after chemotherapy. At the seventh day of discharge from the hospital, our patient admitted to emergency department with acute renal insufficiency. Patient was recruited to hemodialysis for TLS. After 3 cycles of hemodialysis biochemical parameters were normalized. Since then etoposide regimen (100 mg/day for 14 days/monthly) was used. After 4 cycles of oral Etoposide regimen symptomatic relief and incomplete response according to chest radiograph were observed. Our case was presented with a later occurence of TLS when compared with the other cases from literature. We concluded that especially in disseminated small cell lung cancer (SCLC), clinicians must be aware of this rare but fatal complication.Öğe Prognostic significance of blood group antigen expression of tumor tissue in lung cancer patients(Sage Publications Ltd, 2002) Ülger, Ayşe Füsün; Keklik, Tülay; Kumbasar, Özlem Özdemir; Arbak, Peri; Demirkazık, Ahmet; Güngör, Adem; Erekul, SelimAims and background: Many prognostic factors have been evaluated both for SCLC and NSCLC. The prognostic significance of blood group antigen expression of tumor tissues has been studied particularly in NSCLC, yielding divergent results. The aim of the present study was to investigate the prognostic value of the tumoral expression of blood group antigens ABH in lung cancer. Methods: The presence of blood group antigens was assessed immunohistochemically in paraffin-embedded tumor samples from 92 patients diagnosed between 1996 and 1997. Monoclonal antibodies were used to detect blood group antigens. Results: The median survival was longer in NSCLC patients whose tumors were positive for blood group antigen A (P = 0.009). Since the expression of blood group antigen A in tumor cells was limited to patients with type A or AB blood, survival analysis of these patients showed survival to be longer in non-small cell lung cancer patients with blood group antigen A-positive tumors (P = 0.0019). Conclusions: Expression of blood group antigen A in tumor cells is an important, favorable prognostic factor in patients with non-small cell lung cancer, which could be useful to stratify patients with blood group A or AB according to possible outcome, and to guide therapeutic decision-making. The expression of blood group antigens ABH should be evaluated in larger series of lung cancer patients (including small and non-small cell lung cancer) with all blood types.Öğe Relationship between arterial blood gas values, pulmonary function tests and treadmill exercise testing parameters in patients with COPD(Wiley, 2004) Yazıcı, Mehmet; Arbak, Peri; Balbay, Öner; Maden, Emin; Erbaş, Mete; Erbilen, Enver; Albayrak, Sinan; Akdemir, Ramazan; Uyan, CihangirObjective: There have been controversial reports regarding the relationship between exercise tolerance and resting pulmonary function in patients with COPD. The aim of this study was to examine the relationship between resting pulmonary function tests (rPFT) and cardiopulmonary exercise testing parameters (CETP) and their value in estimating exercise tolerance of patients. Methodology: In total, 45 patients with COPD (nine females, 36 males; mean age 61.2 +/- 11.2) and 21 healthy subjects (four females, 17 males; mean age 60.3 +/- 9.7) as a control group were studied. COPD patients (group I) were divided into three subgroups according to their FEV1 (mild/group II: FEV1 60-79% of predicted; moderate/group III: FEV1 40-59%; severe/group IV. FEV1 < 40%). In controls FEV1 was greater than or equal to 80%. Results: There were significant correlations between FEV1 and CETP in group III (maximal O-2 consumption (mVO(2)), r = 0.35, P < 0.005; total treadmill time (TTT), r = 0.31, P < 0.01; total metabolic equivalent values (TMET), r = 0.29, P < 0. 01)) and in group IV (mVO(2), r = 0.49, P < 0.001; TTT, r = 0.45, P < 0.005; TMET, r = 0.31, P < 0.01; peak heart rate (pHR), r = 0.29, P < 0.02; frequency of ventricular extrasystole (fVES), r = -0.27, P < 0.05). Additionally, in group IV there were significant correlations between PaO2 and CETP (mVO(2), r = 0.41, P < 0.02; TTT, r = 0.38, P < 0.03; TMET, r = 0.31, P < 0.05; pHR, r = 0.29, P < 0.05; fVES, r = -0.28, P < 0.05). Conclusion: There are significant correlations of resting FEV1% predicted and PaO2 Values with CETP in patients with moderate and severe COPD and these parameters may also have a role as indicators of exercise tolerance in these COPD patients.Öğe Respiratory symptoms and peak expiratory flow rates among furniture-decoration students(Inst Agricultural Medicine, 2004) Arbak, Peri; Bilgin, Cahit; Balbay, Öner; Yeşildal, Nuray; Annakkaya, Ali Nihat; Ülger, FüsunThis study was designed to evaluate the effects of furniture production, mainly including fir tree (aberia mulleriana), on respiratory health of young workers and to compare the results with those obtained from previous Studies. Sixty-four furniture-decoration students (57 males and 7 females) and 62 controls (54 male, 8 female) from different departments in the same school were included into the Study. All participants were assessed with a questionnaire (concerning history of occupational exposure, work-related respiratory and other symptoms, smoking history, previous asthma history), full physical examination, spirometric evaluation and chest radiograph. Participants then performed serial monitoring of peak expiratory flow rates (PEER) at work and away from work within a month. Mean age of students was 20.9 +/- 3.7 years, 20.5 +/- 2.6 years in controls. There was no difference between study and control groups with regard to age, gender, smoking status and previous asthma history. Reported cough (23.4% vs. 8.1%) and shortness of breath (18.8% vs. 6.5%) were significantly higher in furniture-decoration students than in controls (p = 0.016 and p = 0.034, respectively). Furniture-decoration students had higher conjunctivitis (34.4% vs. 9.7%, p = 0.001) and rhinitis (34.4% vs. 19.4%, p = 0.044) history when compared with controls. Both students and controls were normal in terms of respiratory examination. PEF recordings were performed for approximately one month. Diurnal variability greater than 20% was seen in 12/64 (18.7%) of students at work, whereas it was detected in 4/62 (6.4%) of controls (p = 0,034). When comparing for the presence of diurnal variability greater than 20% in weekends, no difference was found between groups (p = 0.457). In conclusion, early detection of work-related respiratory changes by serial monitoring of peak expiratory flows should save the workers from hazardous respiratory effects of the furniture production, especially in young population.Öğe Seroprevalence of varicella, measles and hepatitis B among female health care workers of childbearing age(Natl Inst Infectious Diseases, 2005) Yavuz, Tevfik; Özdemir, İsmail; Şencan, İrfan; Arbak, Peri; Behçet, Mustafa; Sert, ErhanTo evaluate the relation between infectious agents and reproductive health hazards for health care workers (HCWs), a cross-sectional study consisting of 73 HCWs and 65 bureau workers was conducted. The reproductive health problems of both groups were compared using a questionnaire, and serologic examinations for measles, varicella and hepatitis B were performed. There were no differences between the two groups according to the rate of seropositivity of measles and varicella (P > 0.05). The prevalence of anti-HBc seropositivity was significantly higher among HCWs than controls (31.5 versus 16.9%). There were no differences between seropositive and seronegative subgroups of measles, varicella and hepatitis B regarding the rates of normal delivery time, preterm and postterm delivery and stillbirth. Subjects seropositive for anti-HBc showed a higher spontaneous abortion rate than those who were seronegative (38.2 versus 16.3, P = 0.009). Although these data showed that HCWs had a high rate of anti-HBc seropositivity and that the rate of spontaneous abortion was associated with past hepatitis B virus infection, further studies including larger populations are needed. We considered that it should be strongly recommended that all HCWs be vaccinated against this virus, and future studies should be focused on the relationship between infectious diseases and reproductive health problems in HCWs.Öğe Serum oxidant and antioxidant levels in diesel exposed toll collectors(Wiley, 2004) Arbak, Peri; Yavuz, Özlem; Bukan, Neslihan; Balbay, Öner; Ülger, Füsün; Annakkaya, Ali NihatSerum Oxidant and Antioxidant Levels in Diesel Exposed Toll Collectors: Peri ARBAK, et al. Department of Chest Diseases, Abant Izzet Baysal University, Duzce School of Medicine, Turkey-it has been suggested that exposure to diesel exhaust may lead to adverse effects due to the generation of oxidants. To evaluate the end products of oxidative stress in DE exposure, toll collectors who are considered a high risk group in regard to occupational toxins were compared to controls who had office-based occupations in the same company in this cross sectional study. A total of 38 toll collectors constituted the study group. All subjects were male. The toll collectors and 29 controls were similar regarding age, smoking status and duration of work. All subjects underwent a clinical examination and an interviewer-administrated questionnaire regarding respiratory symptoms, past medical and occupational history, and pulmonary function tests were performed in all subjects. Serum malondialdehyde (MDA), nitrite+nitrate and vitamin E levels were measured. Toll collectors showed higher serum MDA (5.76 +/- 2.15 mumol/L vs. 3.07 +/- 0.76 mumol/L, p=0.0001) and nitrite+nitrate levels (96.50 +/- 45.54 mumol/L vs. 19.32 +/- 11.77 mumol/L, p=0.0001) than controls. Vitamin E levels were similar in toll collectors and controls (10.57 +/- 3.44 mg/L and 9.72 +/- 2.44 mg/L, respectively, p=0.267). There was no difference between groups in terms of the findings of clinical examinations and respiratory symptoms. In pulmonary function parameters, only peak expiratory flow (PEF) in toll collectors was significantly lower than that of controls (88.9% predicted and 104.2% predicted, respectively, p=0.012). In conclusion, we suggest that serum MDA and nitrite+nitrate levels may be used as biological markers of oxidative stress related to DE exposure, but prospective controlled clinical studies are necessary to clarify the possible association between concentrations of MDA and nitrite+nitrate and pulmonary diseases related to DE exposure.Öğe Sigara kullanımına bağlı ağır KOAH gelişen olgularda oküler komplikasyonlar(2003) Tunç, Murat; Arbak, Peri; Balbay, Öner; Erbaş, Mete; Bilen, AbdurrahmanAmaç: Ağır kronik obstrüktif akciğer hastalığı (KOAH) tanısıyla izlenen olgularda gelişebilecek göz komplikasyonlarını araştırmak amaçlanmıştır. Gereç ve Yöntem: Sigara kullanımına bağlı ağır KOAH gelişen toplam 40 hasta oküler bulgular yönünden araştırılmıştır. Elde edilen veriler, yaş ve cinsiyetleri uyumlu, sigara kullanmayan sağlıklı kontrol grubuyla istatistiksel yöntemlerle karşılaştırılmıştır. Sigara kullanımı ve KOAH tedavisinde kullanılan nazal inhaler kortikosteroid gibi ilaçlarla göz bulguları arasındaki ilişki araştırılmıştır. Bulgular: KOAH grubundaki hastaların tümünde 20 yılı aşkın süredir kronik sigara kullanma alışkanlığı mevcuttu. KOAH hastalarının ortalama yaşı 62, kontrol grubunun ise 60 yıldı (p>0.05). KOAH'lı olgularında en sık göz bulgusu, 40 hastanın 16'sında (%40) saptanan katarakttı. (p<0.05) Bu olgularda tespit edilen en sık ikinci göz bulgusu aterosklerotik retinopati (%35) idi. Nazal inhaler kortikosteroid kullanmakta olan 12 olgunun ikisinde (%16) katarakt saptandı ve kontrol grubuyla karşılaştırıldığında aradaki fark anlamlı değildi. (p>0.05) Sonuç: Sigara kullanımına bağlı ağır KOAH gelişen olgularda katarakta sıklıkla rastlanmaktadır. Bu olgular, rutin kontrollerde göz bulguları yönünden de değerlendirilmelidir.Öğe Spontaneous leg haematoma in a patient anticoagulated with nadroparin for suspected pulmonary thromboembolism [1](2004) Balbay, Öner; Tüzüner, Tolga; Arbak, Peri; Orhan, Zafer; Erbaş, Mete; Aydogßan, IekerFixed-dose, subcutaneous Low Molecular Weight Heparin (LMWH) is as effective and safe as adjusted-dose, intravenous unfractionated heparin (UFH) for the initial management of venous thromboembolism and symptomatic pulmonary thromboembolism [1–4]. Clinical experiences indicate that bleeding is a major side effect, not only of UFH, but also of LMWH [5]. An 81-year-old woman (60 kg) was admitted with a clinically suspected pulmonary embolism (SPE) with a 2-day history of pleuritic chest pain and dyspnoea. Her past medical history showed congestive heart failure, atrial fibrillation (AF) and hyperthyroidism, immobilisation due to femoral head fracture 7 years previously. Propylthiouracilcoumadin, aspirin, perindopril, spironolactone, and digoxin were started in May 2000 and propylthiouracil and coumadin was discontinued after 3 months follow-up. Owing both to SPE and chronic AF she was started on nadroparin subcutaneously twice daily 5700 UI AXa/ 0.6 ml. The ventilation/perfusion scan of the lung was reported as having low probability of pulmonary embolism and a duplex ultrasound of the lower limbs was negative for DVT the night after the symptoms started. Despite these findings anticoagulant treatment was continued due to the chronic AF. Except for slightly raised white blood cells and a raised creatinine on admission her laboratory results and coagulation parameters were within normal limits. Two days after anticoagulant treatment, she complained of sudden onset of left leg pain with the finding of a tender haematoma (measuring 51025 cm). There was no history of trauma. Together with nadroparin aspirin was also discontinued.
