Kemal Kara

Obstructive Sleep Syndrom in Patient with Plonjon Guatr: Case Report

A large number of predisposing factors (obesity, nasal obstruction, adenoid hypertrophy, macroglossia, etc.) are reported to be associated with obstructive sleep apnea syndrome (OUAS). In addition to these factors, the large goiter and hypothyroidism were reported to be associated with OSAS as well. However, this relationship could not yet be fully demonstrated. In our case related to plonjon goiter, we wanted to show the effect of hyroidectomy to OSAS –if there is- and the relationship between pressure and OSAS. Two years ago, a 72-year-old female with BMI: 26.8 kg/m2 patient was admitted to our clinic with complaints of respiratory standstill during sleep, snoring, morning headaches and drowsiness during daylight. In the chest X-ray, chest computed tomography and ultrasonography applied to the patient, it was detected that the trachea was deviated to the left due to euthyroid plonjon goiter and severe OSAS and polisomnografisi (PSG) was diagnosed for the patient. The patients apnea-hypopnea index (AHI) was measured 63.1/h. With the aim of treatment, in 7cm H2O pressure, nasal continuous positive airway pressure (nCPAP) was applied to the patient and AHI decreased to the level of 11.4/h. Thyroidectomy was performed one month after the diagnosis. AHI was found 34.8 /h on the PSG applied for the purpose of 8 week-postoperative control. There were recovery on the levels of total sleep time, AHI, obstructive apnea index, hypopnea index, average desaturation index, stage 3 and REM as 16%, 44.8%, 84.7%, 19%, 38.3%, 52.4% and 28% respectively when compared the preoperative term with and postoperative term. It was demonstrated that there was no change of the in the degree of OSAS after thyroidectomy but only some partial improvement in the OSAS. The conclusion that there may be some improvements in nCPAP pressures after thyroidectomy and nCPAP treatment should not be stopped was reached. Also, it should be kept in mind that patients who apply to the primary care centers with the complaints of drowsiness, snorring and fatigue may be diagnosed as OSAS.

A Cystic lesion in Fibula: Hydatid Cyst

A 32-years-old man presented with right posterior calf pain for 4 months duration. He had not any important event in his history. Routine blood parameters were normal. Plain X-ray images of right culf showed advanced cystic, expansile and destructive lesion which was centered at distal fibula. Diagnosis of hydatid bone disease is difficult and depends primarily on clinical, radiologic, and serologic findings. Disease should be suspected in cystic lesions affecting the bone, especially in endemic areas, as it may easily be misdiagnosed

Diagnostic Imaging of Lung Cancer

Lung cancer is the most common cause of cancer related death in men and women. It is frequently seen among men than in women and male-female ratio is 1.5:1. Common epidemiological factors that increase risk of lung cancer is smoking. Early age to start smoking, high number of smoking cigarettes per a day and depth of inhalation increase risk of lung cancer. 25% of patients with lung cancer are nonsmokers that passively exposed to cigarette smoke. Occupational exposure to substances such as asbestos, arsenic, nickel, beryllium, mustard gas increases the risk of lung cancer. The well defined risk factor is exposure to asbestos. In addition advanced age, diffuse pulmonary fibrosis, chronic obstructive pulmonary disease (COPD) and genetic predisposition are the risk factors that increases lung cancer.