[The role of high resolution computerized tomography (HRCT) in the diagnosis and treatment of pulmonary tuberculosis]. / Aktif akciger tüberkülozunun tanisinda yüksek rezolüsyonlu bilgisayarli tomografinin yeri.

In this study we have tried to put forth the role of thorax high resolution computerized tomography (HRCT) in the pursue of the diagnosis and treatment of pulmonary tuberculosis. It was detected that of the 67 patients with active tuberculosis, 66 (98.5%) had centrilobular nodule or branching linear structures, 65 (97%) had acinary nodule, 55 (82%) had consolidation, 55 (82%) had cavities, 54 (80.5%) had tree in bud appearance and 52 (77.6%) were bilateral. Of 30 patients suffering from inactive tuberculosis, 26 (86.6%) were detected to have fibrotic changes, 20 (66.6%) bronchiectasis, 18 (60%) bronchovascular distortion and 14 (46.6%) pericicatrial emphysema. The sensitivity, specificity, positive predictive value, negative predictive values of thorax HRCT in determining the activity of the illness were found as 97%, 86.7%, 94.2% and 92.9% respectively. In conclusion we can say that thorax HRCT is a powerful and reliable diagnostic method for pulmonary tuberculosis. Thorax HRCT can be used as noninvasive diagnostic method especially in the patients suffering from smear and culture negative active tuberculosis.

[The value of fiberoptic bronchoscopy in diagnosis of smear negative pulmonary tuberculosis]. / Yayma negatif akciger tüberkülozu tanisinda fiberoptik bronkoskopinin degeri.

Although mycobacterial culture positivity is the gold standard for the diagnosis, the initial approach to the diagnosis of pulmonary tuberculosis (PTbc) is the detection of acid-fast bacilli (AFB) in respiratory specimens as recommended by the World Health Organization. But the physicians have to make a decision for the patients whose sputum smears are negative or who can not produce sputum. Waiting for culture results with radiological follow up or empirical antituberculous therapy are the standard options. In our study we aimed to assess the diagnostic yield of fiberoptic bronchoscopy in patients, suspected to have tuberculosis, whose sputum smears were negative or who could not produce sputum. Fifty six patients who suspected to have PTbc with sputum smear negative were enrolled in the study (fiberoptic bronchoscopy and selective bronchial washings were done to all patients. Bronchial washings were obtained from the affected parts). Mucosal biopsies were done in patients in where endobronchial abnormalities were noted. Transbronchial biopsies were done in selected patients from the radiological localizations. Ziehl-Nielsen staining and culture in Löwenstein-Jensen medium were the microbiological studies. Typical granulomas were expected to detect on histopathologic examination. Bronchoscopic lavage smears were positive for Mycobacterium tuberculosis in 13 (23%) patients. Twenty eight (50%) patients had positive culture. Histopathological results confirmed tuberculosis in eight of 20 patients who had undergone mucosal biopsies, four of seven of transbronchial biopsies, two of three of needle aspiration biopsies. By bronchoscopic procedures early diagnosis was performed in 27 (48.21%) patients. We concluded that fiberoptic bronchoscopy has an important role in the diagnosis of patients suspected to have tuberculosis, whose sputum smears were negative or who could not produce sputum. It is useful and necessary in selected cases.

[Diagnostic value of postbronchoscopic sputum, bronchoscopic lavage, and transbronchial biopsy in peripheral lung cancer]. / Periferik akciger kanserlerinin tanisinda bronkoskopik lavaj, brons biyopsi ve postbronkoskopik balgam sitolojisinin tani degeri.

The aim of this prospective study was to review the value of bronchoscopic lavage, transbronchial biopsy and postbronchoscopic sputum cytology in peripheral lung cancer. Two groups of patients were involved in the study who were treated in our clinic between the years 1999 and 2001: Group I (22 patients; average age 64 +/- 9 years; 18 males and four females) whose lesions were peripherally localised on chest radiographs and Group II (28 patients; average age 61 +/- 8; 26 males and two females) whose lesions were centrally localised and were visible only by diagnostic bronchoscopic procedures. The following procedures and analysis were done in all patients: Cytologic analysis of prebroncoscopic sputum, bronchoscopic lavage, bronchial biopsy, and patients were asked to give sputum in 30 minutes after bronchoscopy. The final diagnosis of all patients was primary lung cancer. In the first group none of the patients had visible endobronchial lesion on fiberoptic bronchoscopy. Sputum cytology of the patients were negative before bronchoscopy. Bronchoscopic lavage cytology was positive in five of 22 patients (22.7%). Transbronchial biopsy provided better diagnostic yield (50%) than postbronchoscopic sputum (31.8%). In the second group of patients, cytologic analysis was positive 25%, 96.4% and 42.9% in bronchoscopic lavage, bronchial biopsy and postbronchoscopic sputum respectively. Our findings suggest that postbronchoscopic sputum cytology may be an important diagnostic procedure in endoscopically nonvisible pulmonary cancer. Since its application is easy and noninvasive, cytologic analysis of postbronchoscopic sputum may be preferable to bronchoscopic biopsy although a favorable diagnostic yield is not expected.