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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 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 İzole kuzu pulmoner arterlerinde gelişen hipoksik pulmoner vazokonstriksiyonda Gi ve Gs proteinlerinin rolü(Bolu Abant İzzet Baysal Üniversitesi, 2004) Erbaş, Mete; Balbay, Öner7. ÖZET Hipoksik pulmoner vazokonstriksiyon akciğerlerde ventilasyon perfüzyon dengesini sağlayan fizyolojik uyum mekanizmasıdır. Hipoksemi ile seyreden progressif akciğer hastalıklarının patogenezinde önemli rol oynamakla birlikte sağlıklı bireylerde de görülmektedir. Yoğun çalışmalara rağmen, hipoksik pulmoner vazokonstriksiyonun mekanizması henüz bulunamamıştır. G proteinleri vasküler endotel ve düz kas hücrelerinde reseptör aracılıklı sinyal iletimine aracılık ederek vasküler tonusun düzenlenmesinde önemli rol oynayan membrana bağlı protein ailesidir. Biz bu çalışmada, izole kuzu pulmoner arterlerinde izlenen hipoksik vazokonstriksiyonun oluş mekanizmasında Gj ve Gs proteinlerinin rolünü saptamayı amaçladık. Pulmoner arterler yeni kesilmiş kuzuların sol akciğer alt loblarmdan izole edildi. Arterler Krebs-Henseleit solüsyonu ile dolu olan izole organ banyosu asıldı ve izometrik kontraksiyonlar bilgisayarlı poligrafi sistemi ile bağlantılı olan izometrik transdüsır yoluyla devamlı olarak kaydedildi. Solüsyon %75 N2-%20 02- %5 CO2 (Normoksik) ve %95 N2- %5 CO2 (Hipoksik) karışımı içeren gazlar ile havalandırıldı. Organ banyosundaki parsiyel oksijen konsantrasyonu oksijen elektrodu kullanılarak sürekli olarak ölçüldü. Gs ve Gj proteinlerin rolünü araştırmak için bu proteinleri aktive yada inhibe eden kolera ve pertusis toksini kullanıldı. Çalışmada, dinlenme gerimindeki geniş çaplı pulmoner arterlerde hipoksiye bağlı bir gerim artışı izlenmedi ancak hipoksi 3 uM 5-HT ile prekontrakte edilmiş dokularda kontraksiyona (1.7 ± 0.5 mN/mm2, n=10) sebep oldu. Hipoksik vazokonstriksiyon 2 ug/ml kolera toksini ile inkübasyon sonrası inhibe (2.6 ± 0.4 mN/mm2'ten 1.0 ± 0.4 mN/mm2' e kadar, n=6) ve 2 u.g/m.1 pertusis toksini ile inkübasyon sonrası potansiyalize (0.6 ± 0.4 mN/mm2,ten 1.7 ± 0.3 mN/mm2,e kadar, n=6) oldu. Bu sonuçlar Gs ve Gj proteinleri ile ilişkili sinyal iletiminin geniş çaplı izole kuzu pulmoner arterinde gelişen hipoksik vazokonstriksiyonda önemli bir mekanizma olabileceğini gösterdi. Anahtar Kelimeler: Hipoksi, Pulmoner vazokonstriksiyon, Kolera toksini, Pertusis toksini, G proteinleri 34Öğe 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 Kuzu izole pulmoner arterlerinde gelişen hipoksik pulmoner vazokonstriksiyonda Gi ve Gs proteinlerinin rolü(2014) Erbaş, Mete; Balbay, Öner Abidin; Balbay, Ege Güleç; Uzun, Özge; Sılan, CoşkunHipoksik pulmoner vazokonstriksiyon akciğerlerde ventilasyon perfüzyon dengesini sağlayan fizyolojik uyum mekanizmasıdır. Hipoksemi ile seyreden progressif akciğer hastalıklarının patogenezinde önemli rol oynamakla birlikte sağlıklı bireylerde de görülmektedir. Yoğun çalışmalara rağmen, hipoksik pulmoner vazokonstriksiyonun mekanizması henüz bulunamamıştır. G proteinleri vasküler endotel ve düz kas hücrelerinde reseptör aracılıklı sinyal iletimine aracılık ederek vasküler tonusun düzenlenmesinde önemli rol oynayan membrana bağlı protein ailesidir. Biz bu çalışmada, kuzu izole pulmoner arterlerinde izlenen hipoksik vazokonstriksiyonun oluş mekanizmasında Gi ve Gs proteinlerinin rolünü saptamayı amaçladık. Pulmoner arterler yeni kesilmiş kuzuların sol akciğer alt loblarından izole edildi. Arterler Krebs-Henseleit solüsyonu ile dolu olan izole organ banyosuna asıldı ve izometrik kontraksiyonlar bilgisayarlı poligrafi sistemi ile bağlantılı olan izometrik transdüsır yoluyla devamlı olarak kaydedildi. Solüsyon %75 N2 - %20 O2 - %5 CO2 (Normoksik) ve %95 N2 - %5 CO2 (Hipoksik) karışımı içeren gazlar ile havalandırıldı. Organ banyosundaki parsiyel oksijen konsantrasyonu oksijen elektrodu kullanılarak sürekli olarak ölçüldü. Gi ve Gs proteinlerin rolünü araştırmak için kolera ve pertusis toksini kullanıldı. Çalışmada, dinlenme gerimindeki geniş çaplı pulmoner arterlerde hipoksiye bağlı bir gerim artışı izlenmedi ancak hipoksi 3 mM 5-HT ile prekontrakte edilmiş dokularda kontraksiyona (1.7±0.5 mN/mm2, n=10) sebep oldu. Hipoksik vazokonstriksiyon 2 mg/ml kolera toksini ile inkübasyon sonrası inhibe (2.6±0.4 mN/mm2’den 1.0±0.4 mN/mm2’ye kadar, n=6) ve 2 mg/ml pertusis toksini ile inkübasyon sonrası potansiyalize (0.6±0.4 mN/mm2’den 1.7±0.3 mN/mm2’ye kadar, n=6) oldu. Bu sonuçlar Gi ve Gs proteinleri ile ilişkili sinyal iletiminin geniş çaplı kuzu izole pulmoner arterinde gelişen hipoksik vazokonstriksiyonda önemli bir mekanizma olabileceğini gösterdi.Öğe Persistent serpentine supravenous hyperpigmented eruption associated with docetaxel(Wiley, 2005) Aydoğan, İlker; Kavak, Ayşe; Parlak, Ali Haydar; Alper, Murat; Annakkaya, Ali Nihat; Erbaş, MeteVarious mucocutaneous reactions have been reported with the use of systemic docetaxel. We describe a 47-year-old man who developed a persistent serpentine supravenous hyperpigmented eruption (PSSHE), beginning at the site of docetaxel injection and spreading along the superficial venous network in the anterior aspect of the right forearm and distal arm. The eruption occurred after the first infusion of docetaxel following insufficient venous washing. A second infusion was administered through a vein in the other forearm, but this time, abundant venous washing was performed and a similar eruption did not occur. To our knowledge, this is the second report of docetaxel-induced supravenous discoloration and we discussed the terminology and mechanism of this unique reaction.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 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.Öğe Which patients are able to adhere to tuberculosis treatment? a study in a rural area in the northwest part of Turkey(Natl Inst Infectious Diseases, 2005) Balbay, Öner; Annakkaya, Ali Nihat; Arbak, Peri; Bilgin, Cahit; Erbaş, MeteThe purpose of this study was to investigate various factors, including demographical, socioeconomical, clinical and radiological features, of adherent and nonadherent patients with tuberculosis (TB) who were admitted to a university hospital between 1998 and 2003. One hundred and one patients (65.5%) and 53 patients (34.5%) met the criteria of adherence and nonadherence, respectively. A higher rate of adherence was observed among females than males (79.2 versus 58.4%, respectively, P = 0.012). Older patients were more nonadherent (P = 0.008). The adherence rate in non-smokers was significantly higher than that of smokers (81.4 and 52.4%, respectively, P = 0.000). Patients who underwent "family screening" were more adherent (75.7%) than those (39.5%) who did not (P = 0.000). Patients with pleurisy had higher adherence rates (81.3%), followed by patients with pulmonary TB (65.0%), while patients with extrarespiratory TB had the lowest adherence rates (45.5%) (P = 0.024). The presence of cough was significantly associated with adherence (P = 0.049). A significantly higher adherence rate was observed in patients without hemoptysis (P = 0.001). A univariate logistic regression confirmed that age, smoking, family screening, type of TB, cough and hemoptysis had significant independent effects on the adherence to treatment of TB. High-risk patients may be identified and interventions tailored to promote adherence before concluding that the patient is willfully refusing treatment.
