[Comparison of clinical assessments with computerized tomography pulmonary angiography results in the diagnosis of pulmonary embolism]. / Pulmoner emboli tanisinda klinik olasiliklarin bilgisayarli tomografi pulmoner anjiyografi bulgulari ile karsilastirilmasi.

Pulmonary embolism (PE) is difficult to diagnose. We investigated the relationship between computed tomography pulmonary angiography (CTPA) with clinical assessments and thrombus localization. 56 patients with the suspicion of PE; 27 male, 29 female were included. They were evaluated by empirical and Wells clinical assessments, tested with D-Dimer. According to the combination of both CTPA was performed where necessary (if one of the clinical assessments was high or intermediate or those with low clinical probability and high D-Dimer) in the algorithm we used. CTPA was regarded as gold standard. Dyspnea, chest pain, tachypnea, crackles were the most common symptoms and signs in patients having PE. Recent surgery within the risk factors was significantly higher in the PE present group. PE was diagnosed in 31 (55.4%) patients with CTPA. According to the empirical assessment 20 (64.5%) of the patients had high, 10 (32.3%) had intermediate and 1 (3.2%) had low clinical probability within 31 PE present group, while with Wells scoring 8 (25.8%) had high, 17 (54.8%) had intermediate and 6 (19.4%) had low clinical probability. Sensitivity of the empirical assessment and Wells scoring was 97%, 80% while the specificity was 16%, 68% respectively. Positive and negative predictive values of empirical assessment were 59%, 80% and these values of Wells scoring were 76%, 73% respectively. Thrombus was localized in main pulmonary arteries in 45.8% of patients with high clinical probability according to the empirical assessment. With Wells scoring in 45.5% of the high probability patients and only in 4.3% of the low probability patients thrombus was there. PE can be diagnosed noninvasively. Since PE can easily be underdiagnosed, empirical assessment which is more sensitive will be appropriate. There is a significant correlation between clinical assessments and presence of PE in CTPA. As the severity of clinical assessment increases, thrombus settles more proximal.

[Microbiological results of bronchoalveolar lavage that was performed for opportunistic pulmonary infections]. / Firsatçi pulmoner infeksiyon ön tanisiyla yapilan bronkoalveoler lavajin mikrobiyolojik sonuçlari.

Between 2001-2002; in 62 cases, 33 (53%) male, 29 (47%) female, mean age 51.4 +/- 18.1 years) bronchoalveolar lavage (BAL) was performed for diagnosis of opportunistic pulmonary infection and specimens were evaluated for results of microbiological examinations. There was hematological malignancy in 18 (29%) and solid organ malignancy in 13 (21%) cases. Thirty-one (50%) cases were immunocompromised for reasons other than malignancy. By endoscopic evaluation endobronchial lesion was seen in 2 (3%) cases, indirect tumor signs were seen in 2 (3%) cases and signs of infection were seen in 11 (18%) cases. Forty-even (76%) cases were endoscopically normal. Acid-fast bacilli (AFB) direct examination was positive in 3 (5%) cases. In 4 (6%) cases mycobacterial culture was positive, Mycobacterium tuberculosis-polymerase chain reaction (PCR) was also positive in these four cases. Examination of gram-stained smears for bacteria was associated with infection in 14 (23%) cases. Bacteriologic cultures were positive for single potential pathogen in 10 (16%) cases, and for mixed pathogens in 7 (11%) cases for a total number of 17 (27%). Fungal cultures were positive in 3 (5%) cases all of which had hematological malignancy. As a result in 24 (39%) cases microbiological agent of infection is determined: in four mycobacteria, in 17 bacteria other than mycobacteria and in three fungi.