Aralýk 2019'da Wuhan þehrinde ortaya çýkmasýndan bu yana, koronavirüs hastalýðý (COVID-19) Çin'e hýzla yayýldý. COVID-19 enfeksiyonuna baðlý yüksek oranda hastaneye yatýþ görülmesine raðmen, spesifik bir tedavi bildirilmemiþtir. Bu baðlamda antiviral tedavi seçimi sýnýrlýdýr. Japonya'da influenza için onaylanan Favipiravir, RNA'ya baðýmlý RNA polimerazý (RdRP) hedefleyen ilaçlardan biridir. Özellikle orta þiddetteki COVID-19 olgularýnda ateþ, öksürük dispnesi ve oksijen tedavisi veya noninvazif mekanik ventilasyon ihtiyacýný önemli ölçüde azalttýðý bilinmektedir. Bu yazýda, hastalarý yoðun bakým ünitesine kabul etmeden önce klinik durumlarý kötüleþen ve favipiravir ile takip edilerek iyileþen dört olguyu sunduk.

After emerging in Wuhan city in December 2019, the coronavirus disease 2019 (COVID-19) rapidly spread throughout China. Although high rates of hospitalization are seen with COVID-19, no specific treatment has been reported, and the choice of antiviral therapies is limited. Favipiravir, approved in Japan for influenza, is one of the drugs that targets RNA-dependent RNA polymerase (RdRP). It significantly decreases the duration of fever, cough dyspnea, and the need of oxygen therapy or noninvasive mechanical ventilation, especially in moderate COVID-19 cases. In the current paper we presented four cases with worsening clinical conditions and the development of hypoxia who were treated with Favipiravir before being admitted to the intensive care unit, and who recovered from the disease.

Kimura hastallýðý nadir izlenen benign kronik inflamatuar bir hastalýktýr ve etyolojisi belirsizdir. Taný koymak oldukça zor ve tanýda doku örneklemesi gereklidir. Eozinofili, artmýþ serum immunoglobulin E deðerleri ve baþ ve boyunda subkutan nodüller klasik triadýný oluþturmaktadýr. Burada, servikal, supraklavikular ve mediastende multiple lenfadenopati ile baþvuran 33 yaþýnda bir hastayý sunduk. Olgumuz lenfoma ön tanýsýyla danýþýldý. Supraklavikular lenf nodu eksizyonu sonrasýnda Kimura Hastalýðý olarak taný konuldu.

Kimura disease is rarely seen benign chronic inflammatory disease, the etiology of which is unknown. The diagnosis of the disease is challenging, and so histopathological sampling is necessary. Eosinophilia, increased serum immunoglobulin E levels and subcutaneous nodules in the head and neck are the classical triad indicators of the disease. Herein, we present the case of a 33-year-old man with multiple lymphadenopathies in the area of neck, supraclavicular and mediastinum. The patient was pre-diagnosed with lymphoma. After a supraclavicular lymph node excision, the diagnosis was re-evaluated as Kimura Disease.

Pulmoner kapiller hemanjiomatozis (PKH) nadir görülen, ilerleyici ve çoðunlukla pulmoner hipertansiyon ile birlikte bulunan akciðerlerin vasküler bir hastalýðýdýr. Hastalýkla iliþkili mesleksel risk faktörleri ile ilgili araþtýrma azdýr. Ayný iþletmeden baþvuran 8 olgunun 3 ‘ünde benzer radyolojik bulgulara rastlandý, olgularýn yalnýzca bir tanesi akciðer biopsisini kabul etti. Kýrk yaþýnda erkek olgunun herhangi bir yakýnmasý yoktu. Bilgisayarlý tomografide her iki akciðerde orta derecede peribronþiyal kalýnlaþma ve alt bölgelerde mozaik perfüzyon paterni izlendi. Kardiyak deðerlendirmede sað kalp yetmezliði saptanmadý. Akciðer biopsisinde alveolar septada kapiller benzeri vasküler proliferasyon görünümü izlendi. Ayný iþletmeden benzer 3 radyolojik bulgu olmasý ve literatür bulgularý eþliðinde mesleksel maruz kalým ile iliþkili PKH olgusu olabileceði düþünüldü. PKH etiyolojisi halen bilinmeyen bir hastalýktýr. Mesleki maruziyetler PKH için potansiyel bir risk faktörü olarak bildirilmektedir. Herhangi bir hastalýk için bilinen klasik epidemiyolojik özelliklerin karþýlanmadýðý durumlarda mesleki etiyolojinin deðerlendirilmesi unutulmamalýdýr.

Pulmonary capillary hemangiomatosis (PCH) is a rare and progressive vascular disease of the lung that causes pulmonary hypertension, as they frequently overlap. The occupational risk factor associated with PCH is rarely discussed. In the present report, three of the eight patients admitted from the same company had similar radiological findings, and one agreed to undergo a biopsy. A 40-year-old male who was working as a foundry worker with no symptoms underwent CT, which showed moderate peribronchial thickening in both lungs and a mosaic perfusion pattern in the lower zones. There was no evidence of right heart failure. A microscopic examination of the lung by thoracoscopic resection showed capillary-like vascular proliferation in the alveolar septa. As there were workers with similar radiological findings from the same company he was diagnosed with occupational PCH. The etiology of PCH remains unknown. Occupational exposure should be kept in mind if a disease does not meet the classic epidemiological characteristics.

Septik pulmoner emboli, birincil enfeksiyon kaynaðýndaki mikroorganizma içeren trombüsün dolaþýma karýþmasý sonucu, pulmoner arterlerde enfarkt ve akciðer parankiminde bilateral multipl nodül ve/veya kaviteye yol açan nadir bir enfektif akciðer hastalýðýdýr. Olgumuz, 58 yaþýnda KOAH alevlenme tanýsýyla yatýrýlmýþ olup, yatýþýnýn 4. gününde ateþ, öksürük, nefes darlýðýnda artýþ, akciðer grafisinde bilateral yaygýn infiltrasyon geliþmesi üzerine yoðun bakýmda invazif mekanik ventilatörde takip edildi. Toraks bilgisayarlý tomografisinde; periferik yerleþimli ve bazýlarý kaviter olan nodüller, infiltrasyon, maximum 1 cm olan mediastinal lenfadenomegali, bilateral plevral effüzyon ve besleyici damar belirtisi izlendi. Geniþ spektrumlu antibiyotik ve antifungal tedaviye yanýt alýnamayan hastanýn exitusundan sonra trakeal aspirat kültüründe Acinetobacter baumannii / calcoaceticus (antibiyogramýndaki antibiyotiklerin tümüne dirençli) üremesi saptandý. Mortalitesi yüksek olan septik pulmoner emboli etyolojisinde gram negatif pnömoni saptanmasý nadir bildirilmiþ olup, bu nedenden dolayý olguyu literatür eþliðinde tartýþmayý amaçladýk.

Septic pulmonary embolism is an infective lung disease that leads to infarction in the pulmonary arteries and bilateral multiple nodules and/or cavitations in the lung parenchyma resulting from the circulation of thrombus in the bloodstream as infected with microorganisms in the primary infectious focus. A 58-year-old case we have presented was hospitalized with the diagnosis of COPD exacerbation and was taken to the intensive care unit to be monitored in the invasive mechanical ventilator because of fever, cough, increased dyspnea and development of bilateral diffuse infiltration encountered by chest x-ray. Thoracic computed tomography encountered peripherally localized and partly cavitary nodules, infiltration, mediastinal lymphadenomegaly with a maximum diameter of 1 cm, bilateral pleural effusion and feeding vessel sign. After exitus of the patient who was unresponsive to broad spectrum antibiotic and antifungal therapy; tracheal aspirate culture test indicated the growth of Acinetobacter baumannii /calcoaceticus (resistant to all the antibiotics in the antibiogram). The detection of Gram Negative Pneumonia has been rarely reported in the etiology of septic pulmonary embolism that presents a high mortality rate, therefore, we aimed to discuss that case in the light of literature data.

Ultrasonografi acil servislerde tanýsal ve invazif amaçlar için yaygýn olarak kullanýlmaktadýr. Bu yazýda, point-of-care-ultrasonography incelemesi ile akciðer parankiminde kist hidatik ve pnömoni tanýsý konulan edinilmiþ immün yetersizlik sendromlu bir olguyu sunuyoruz.

Ultrasonography is widely used for diagnostic and invasive purposes in emergency departments. We present here a case with acquired immune deficiency syndrome who was diagnosed with a hydatid cyst and pneumonia in the lung parenchyma during a point-of-care-ultrasonography examination.

Penentran yaralanma sonrasý yabancý cismin çýkarýlmasý önemli bir problemdir. Otuz iki yaþýnda erkek hastanýn inþaat demiri üzerine düþme sonrasý demir parçasý sol umlikusun lateralinden girip skapula arkasýndan çýkmýþtý. Fizik muayene ve gerekli radyolojik tetikler yapýldýktan sonra hasta ameliyata alýndý. Demir çubuðun konumundan dolayý fizik muayene, radyolojik tetkikler, entübasyon ve ameliyat, hafif sol lateral dekübit pozisyonda yapýlarak demir parçasý çýkarýldý. Sonuç olarak, bu tür olgular az görülmekle birlikte; acil ve cerrahi ekibin koordineli olarak çalýþmasý çok önemlidir.

The removal of the foreign body form the body after a penetrant injury is critical. A 32-year-old male patient presented to our facility after falling on an iron reinforcement bar (rebar) while working on a construction site. The iron bar had entered the lateral side of the patient’s left umbilicus and exited from the posterior scapula. After a physical examination and the necessary radiological investigations, the patient was operated on. Due to the position of the iron bar, the physical examination, radiological examinations, intubation and surgery were conducted with the patient slightly left of the lateral decubitus position, and the iron bar was removed. Although such cases are encountered only rarely, we consider it to be crucial for the emergency and surgical teams to work in coordination.

Yirmi sekiz yaþýnda erkek hasta, acil servise hemoptizi þikayetiyle müracaat etti. Solunum sistemi muayensinde solda solunum sesleri azalmýþtý ve tomografide alt lobda týkayýcý polipoid bir lezyon ve distalinde atelektazi vardý. Bronkoskopide sol ana bronþa taþan polipoid lezyon görüldü. Lezyonun görünen kýsmýndan snare ile biyopsi alýndý ve cryo ile hemostaz saðlandý. Patolojisi fibrosarkom gelen hastaya sleeve sol alt lobektomi uygulandý. Lenf nodlarý ve cerrahi sýnýrlar negatif bulundu. Hastaya kemo/radyoterpi tedavi uygulanmadý. Primer pulmoner fibrosarkomlarýn polipoid olarak büyümesi nadir görülmektedir. Bu hastalarda tercih edilen tedavi þekli cerrahi eksizyondur.

A 28-year-old male presented to the emergency department with hemoptysis. A pulmonary examination revealed diminished lung sound on left side, and a CT scan of the chest showed an endobronchial polipoid lesion in the left main bronchus. A rigid bronchoscopy showed a polipoid lesion in left the main left bronchus, while the orifice of the lower lobe was not visible. The lesion was cut into two pieces with a snare and removed with cryotherapy, and hemostasis was achieved. A pathological examination of the lung bronchial biopsy specimen revealed fibrosarcoma. A left lower sleeve lobectomy was performed, and as surgical margins were tumor free, no chemo/radiotherapy was considered necessary. Primary endobronchial pulmonary fibrosarcomas exhibiting polypoid growths are rare. Surgical excision is the preferred treatment option in such patients

Ýzole kosta tutulumu, Langerhans hücreli histiyositozisin (LCH) en nadir tutulum bölgelerinden biridir. Biz burada, tek yakýnmasý sol 7. kostanýn posterolateral bölgesinde soliter osteolitik lezyona baðlý aðrý olan, 29 yaþýnda bir kadýn olguyu sunuyoruz. Hastada 7. kosta, taný ve tedavi amaçlý rezeke edildi. Histopatolojik bulgular LCH ile uyumlu bulundu.

Isolated rib involvement is one of the rarest sites for the clinical presentation of Langerhans cell histiocytosis (LCH). We report here on the case of 29-year-old female whose only symptom was pain, radiating to the solitary osteolytic lesion at the posterolateral aspect of her seventh rib. The 7th rib was resected for diagnostic confirmation and treatment, and histopathological findings were found to be compatible with the LCH.

Trakeabronkopatia osteokondroplastika nadir görülen, trakea ve bronþ lümenine doðru çýkýntý yapan çok sayýda osseöz ve kartilajönez nodüller ile karakterize benign bir hastalýktýr. Etyolojisi belli deðildir. Yetmiþ beþ yaþýnda kadýn hastaya bir yýldýr devam eden dispne ve öksürük þikayeti nedeni ile çekilen toraks bilgisayarlý tomografide trakea ve anterior mediastende kitle saptandý. Bronkoskopide trakeada yaklaþýk 4-5 kýkýrdak halka kadar ilerleyen, lümeni % 70’ ye yakýn daraltan kitle lezyonu görüldü. Distalinde karinaya yaklaþýk 2 kýkýrdak halka mesafe yerleþimliydi. Hastaya sað torakotomi ile trakeal sleeve rezeksiyon ile uç uca anastomoz ve timektomi operasyonu uygulandý. Histopatolojik incelemelerin sonucu trakeabronkopatia osteokondroplastika ve timik kist ile uyumlu olarak deðerlendirildi. Postoperatif dönemde kompikasyon geliþmedi. Olgu trakeabronkopatia osteokondroplastika ve timik kist birlikteliði çok nadir görüldüðü için sunulmuþtur.

Tracheobronchopathia osteochondroplastica is a rare benign disease that is characterized by multiple submucosal osseous and cartilaginous nodules in the tracheal bronchus. The etiology is not clear. A thoracic computed tomography of a 75 year-old female patient with complaints of dyspnea and cough for a year revealed two different lesions on the trachea and the anterior mediastinum. A bronchoscopy revealed a solid mass in the distal part of the trachea, affecting 4–5 cartilaginous rings and restricting the tracheal lumen by approximately 70%. The mass was located approximately two cartilaginous rings distant to the carina. A tracheal sleeve resection and thymectomy were performed through a right thoracotomy. The histopathological results indicated tracheobronchopathia osteochondroplastica and a thymic cyst. The postoperative follow up was uneventful. We report this rare case since the co-existence of tracheobronchopathia osteochondroplastica and the thymic cyst is a condition rarely seen in literature.

Marfan sendromu (MFS), otozomal dominant geçiþli baþlýca kardiyovasküler, oküler, kas-iskelet ve sinir sistemlerini etkileyen bir bað dokusu bozukluðudur. MFS’lu olgularýn %66-91’inde 15. kromozomdaki fibrillin -1 (FBN1 ) gen mutasyonu saptanmýþ olmakla beraber, olgularýn %27’si yeni mutasyonlardan kaynaklanýr. Yetiþkinlerde klinik taný Ghent kriterlerine göre yapýlmalýdýr. Erken taný, aortu koruyucu medikal ve cerrahi tedaviler ve düzenli takip ciddi komplikasyonlarýn önlenmesine veya geciktirilmesine yardým eder. Otuz yaþýnda pürülan kanlý balgam, ateþ ve terleme þikayetleri olan Marfan sendromu tanýsý koyduðumuz olgumuzu sunduk.

Marfan syndrome (MFS) is a connective tissue disorder inherited by autosomal dominant pattern that affects primarily cardiovascular, ocular, musculoskeletal and nervous systems. Even though, mutation in the fibrillin-1 gene (FBN1) located on Chromosome 15 was detected in 66-91% in the case with MFS, 27% of the cases were caused by novel mutations. The clinical diagnosis in adults is established according to Ghent Criteria. Early diagnosis, aortic valve-sparing medical and surgical treatments, and regular patient follow-up are helpful in preventing and delaying serious complications. In this case report, we have presented a 30-year-old case who admitted to the hospital due to the complaints of purulent bloody sputum, fever and sweating, and was diagnosed with Marfan syndrome.