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    Acute oxygen treatment
    (2004) Kizkin O.; Hacievliyagil S.S.; Günen H.
    Oxygen treatment is commonly used in clinical practice. Although this treatment was taught during medical education under different titles, it is observed that doctors do not administer oxygen treatment in adequate periods and doses. The possible cause of this may be that oxygen is not considered as a drug. The results of inadequate dose and insufficient monitoring in oxygen treatment would be serious. On the other hand, failure to correct hypoxaemia fearing from hypoventilation and carbon dioxide retention is not acceptable. For a safe oxygen treatment, doctor must know its indications, oxygen delivery systems, flow rates and monitoring. The aim of this review is to refresh our knowledge about when, how and how much to start oxygen treatment and how to monitor it.
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    The cost of treatment in new case and multidrug resistant case in pulmonary tuberculosis
    (2003) Kizkin O.; Hacievliyagil S.S.; Türker G.; Günen H.
    The treatment of multidrug-resistant pulmonary tuberculosis (MDR-Tbc) is quite difficult, and the disease has high morbidity and mortality rates. This study was designed to compare the costs of treatment in new tuberculosis (new-Tbc) cases and MDR-Tbc cases. Data base of the study was composed of the data from therapy principles of new-Tbc cases and MDR-Tbc, and official directives and price lists of Turkish Pharmacology Society in 2001 fiscal year regulating treatment costs. For new-Tbc cases, the treatment cost included expanses for 20 days of hospitalisation, one month work loss and six months drug supply and laboratory costs; for MDR-Tbc cases, it was comprised by expenses for seven months hospitalisation in average, 12 months work loss, 24 months drug supply and laboratory costs, and probable surgical interventions and post-operative intensive care. The service of hospital stuff and medical equipment provided was disregarded. The cost analyses was calculated as charge price of American dollars ($) dated 14.09.2001. It was found that the cost of therapy for new-Tbc cases and MDR-Tbc cases were 1134.89 $ and 17529.15 $, respectively. In MDR-Tbc cases, the costs of hospitalisation, work loss, drug therapy and laboratory procedures were 10.5, 12, 98.7 and 5.3 times higher respectively, when compared with those of new-Tbc. The cost of thoracotomy for one patient including the cost for 10 days period of post-operative care in intensive care unit was 391.93 $. The treatment of MDR-Tbc has a high cost, and 16 new-Tbc cases can be treated with the same cost in our country. In conclusion, we think that successful treatment strategies for both new-Tbc cases and MDR-Tbc cases will lower the cost of tuberculosis treatment.
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    The principles of mechanical ventilation in ARDS
    (2004) Günen H.; Kizkin O.
    Acute respiratory distress syndrome (ARDS) is a real challenge for the pulmonary and critical care physicians. Although it is quite frequently encountered in intensive care clinics, its diagnosis and treatment bare many variations among the clinicians. Since ARDS is a fully dynamic process, there is no uniform application of mechanical ventilation (MV) being one of the inevitable components of ARDS management. This situation makes the clinicians very prone to make mistakes during setting and subsequent adjustments of mechanical ventilation parameters. In this review, we aimed to clarify the most common issues of discussion by presenting the principles of MV in ARDS with regard to some recent modifications.
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    The role of surgery in chest wall tuberculosis
    (2004) Kuzucu A.; Soysal Ö.; Günen H.
    Chest wall tuberculosis is a rare entity and its clinical presentation may resemble a pyogenic abscess or chest wall tumor. The role of surgery in the diagnosis and treatment of chest wall tuberculosis is still controversial. During a 6-year period (1997-2002), six cases with cold abscesses of chest wall were managed in our clinic. Clinical presentation, diagnostic workup, treatment strategies, and results of medical and surgical treatment were retrospectively reviewed. There were four male and two female patients. All but one had a fluctuating and abscess-like chest wall mass. Pleura and mediastinal or chest wall lymph nodes were also involved in three patients. Before the debridement and abscess drainage, the diagnosis was not confirmed in any of our patients except one. All received a four-drug antituberculous regimen for 6-12 months postoperatively and improved clinically and radiologically. Surgical intervention and histological examination are usually necessary for the treatment and to confirm the diagnosis in chest wall tuberculosis. Antituberculous medical treatment and adjunctive surgery are quite effective in this process. © 2003 Elsevier B.V. All rights reserved.