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}{% \vskip8pt \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}} \vskip16pt } \usepackage[absolute,overlay]{textpos} \makeatother \usepackage{lineno} \linenumbers \begin{document} \author[1]{Gulfidan Cakmak} \author[2]{Zuhal Aydan Saglam} \affil[1]{ Haseki Training and Training Hospital} \renewcommand\Authands{ and } \date{\small \em Received: 7 February 2013 Accepted: 5 March 2013 Published: 15 March 2013} \maketitle \begin{abstract} Consultation means refering a case to the related specialist in order to have his/her opinion and manage the treatment of the patient accordingly (1,2). Pulmonary consultations are requested commonly from nearly every inpatient clinic. Cases are generally consulted following the determination of a clinical or radiological pathology at pulmonary system in order to have the patients assessed by the pulmonologist?s point of view regarding diagnosis, treatment or at the preoperative state. This study retrospectively evaluates the records of the consultations asked from Clinics of Chest Disease. \end{abstract} \keywords{} \begin{textblock*}{18cm}(1cm,1cm) % {block width} (coords) \textcolor{GJBlue}{\LARGE Global Journals \LaTeX\ JournalKaleidoscope\texttrademark} \end{textblock*} \begin{textblock*}{18cm}(1.4cm,1.5cm) % {block width} (coords) \textcolor{GJBlue}{\footnotesize \\ Artificial Intelligence formulated this projection for compatibility purposes from the original article published at Global Journals. However, this technology is currently in beta. \emph{Therefore, kindly ignore odd layouts, missed formulae, text, tables, or figures.}} \end{textblock*} \let\tabcellsep& \section[{I.}]{I.}\par Summary ur aim was to evaluate the results of Chest Disease Clinic consultations. \section[{Pulmonary consultations in Haseki Training and Research}]{Pulmonary consultations in Haseki Training and Research}\par Hospital between years 2008 and 2012 were retrospectively evaluated.The clinic from which the consultation was demanded, the reason for consultation, anamnesis of the patient, findings for physical biochemical and radiological examination and comorbid diseases as well as a preceding pulmonary disease were recorded.\par The consultations were mostly required by Clinic of Internal Medicine (27.6\%) for patients with radiological and clinical abnormalities in order to have suggestions for diagnosis and treatment (64.6\%). The most frequent symptom was dyspnea (41\%). 21.6\% of the patients had a preceding pulmonary disease which was COPD most commonly. 35.5\% of the patients had a comorbid disease and most frequently it was hypertension. We noted that internists requested pulmonary consultations mainly for confirmation of diagnosis and treatment, while the surgents requested it for preoperative evaluation and predicting/avoiding postoperative complications by planning the appropriate management. \section[{II.}]{II.} \section[{Materials and Methods}]{Materials and Methods}\par The records of five thousand three hundred and sixty patients consulted by Chest Disease Clinic were retrospectively analysed. The rationales for consultations were classified as requisition for 1) preoperative assesments 2) suggestions for diagnosis and treatment. The basic sociodemographic data of the patients (age, gender), comorbid diseases, history of smoking, \hyperref[tab_1]{1}).\par 3664 of consulted patients (68.4\%) didn't have a preceding pulmonary disease while 1696 (31.6\%) had a pulmonary disease before which were commonly COPD and pulmonary infections (9.1\% and 6.9\% respectively). Internal Medicine and Surgery were the departments which required consultations most (27.6\% and 21.6\% resp.). (Table \hyperref[tab_2]{2}).\par 904 of patients (16.9\%) did not have any of the pulmonary system findings as cough, sputum, dyspnea, chest pain or hemoptysis while 4456 (83.1\%) had at least one (Table \hyperref[tab_3]{3}). Pulmonary function testing (PFT)was ordered for 1376 (25.7\%) of patients with any of these symptoms and 1216 had undergone blood gas analysis (BGA) (22.7\%). 3456 of patients (64.5\%) did not haveany associating comorbid disease while 1904 had at least one (35.5\%). The most frequent comorbid disease was hypertension {\ref (} IV.\par Nowadays, consultations are more oftenly required because of extreme specialisation in very branch as well as increase in production of medical knowledge, widespread utilisation of interventions requiring special education and technique and increase in juristic and public pressure on doctors \hyperref[b0]{(1,}\hyperref[b2]{2)}. Therefore it is necessary for the doctors to work together in order to acquire a holistic point of view \hyperref[b0]{(1,}\hyperref[b2]{2,}\hyperref[b3]{3)}. In our hospital pulmonary consultations are required mostly for a preoperative evaluation or any pulmonary pathology. For most of our patients (64.4\%) consultations were required for suggestions of diagnosis and treatment modality. This result is similar to Öztürk and colleagues' study. The most common symptom was dyspnea and cough (41\% and 18.7\% resp.) This result is also similar to the results of Zamani, Annakkaya, Ozturk, Gulec et al \hyperref[b4]{(4,}\hyperref[b5]{5,}\hyperref[b0]{1,}\hyperref[b6]{6,}\hyperref[b7]{7)} Pulmonary consultations are required by almost every clinic which were mostly from Departments of Internal Medicine and Surgery(27.6\% and 21.6\% resp.).Arslan, Annakkaya, Ozturk, Ucar et al. reported in their studies that the most common request was from departments involving surgery(7,5,1,8). Consultation requests from Internal Medicine were mainly for diagnosis and treatment while surgical departments wanted additional preoperative evaluation. This outcome is also parallel to the results of the study of Arslan et al \hyperref[b7]{(7)}.\par Preoperative evaluation is critically important in order to foresee possible postoperative complications and avoid them. 35.6\% of our patients were consulted for preoperative evaluation. The percentages were 31 and 61 at Karnak's and Annakkkaya's studies respectively \hyperref[b9]{(9,}\hyperref[b5]{5)}. Discussion may be listed as age, smoking, general health condition (ASA>class 2), obesity, nutritional status, associating pulmonary infection and COPD \hyperref[b10]{(10)}. Half of our patients were smokers yet most of them did not have established pulmonary disease.\par Advanced age, especially over 70 is an important risk factor increasing mortality and morbidity. \hyperref[b4]{(4,}\hyperref[b7]{7,}\hyperref[b11]{11)}. Our patients' age ranged between minimum 14 and maximum 98 years. (61.28±14.89). Associating COPD is also an important risk factor for development of postoperative pulmonary complications \hyperref[b0]{(1)}. Furthermore pharmaceuticals used at the management of COPD are reported to be causative risk factors for arrythmias and increasing cardiac complications \hyperref[b9]{(9)}.\par The most common ordered tests were PFT and ABG (25.7\% and 22.7\% resp.). Pulmonary Function Testing (PFT) is a cheap, simple and widely used method for evaluating the pulmonary symptoms and findings, diagnosing obstructive or restrictive pulmonary diseases, identifying the severity of pulmonary impairment and managing which should be certainly performed in patients who will be undergoing pulmonary resection \hyperref[b8]{(8)}. PFT has a critical importance especially at identifying the main pathology in acute and undetermined dyspnea and at managing the treatment \hyperref[b7]{(7,}\hyperref[b8]{8)}. The frequency of ordering PFT and ABG was 13\% and 49\% in our study which was 66\% and 29\% respectively in the study by Arslan et al \hyperref[b7]{(7)}.\par The most common pulmonary complications were pneumonia, respiratory insufficiency, bronchospasm, atelectasis, prolonged air leakage, bronchopleural fistula, empyema and exacerbation of pre-existing COPD \hyperref[b9]{(9,}\hyperref[b10]{10,}\hyperref[b11]{11)}. We determined 110 cases showing at least one of these postoperative complications above. The most common complications were fever and dyspnea. Mortality wasn't observed according to these complications.\par 24.4\% of consulted patients were permitted to have operation, 44\% were offered further examination and/or medical treatment. Ucar et al reported that they offered medical treatment to 37\% of the patients they had consulted and for 29\% they did not have an objection for operation \hyperref[b8]{(8)}. Arslan et al reported these numbers respectively 34\% and 30\% \hyperref[b7]{(7)}.\par We concluded that pulmonary consultations are mainly requested by departments of internal medicine for diagnosis and management of dyspnea. Departments of surgery needed consultation additively for preoperative evaluation. We think that pulmonary consultation for preoperative evaluation is crucial in diagnosing and managing the diseases.\begin{figure}[htbp] \noindent\textbf{}\includegraphics[]{image-2.png} \caption{\label{fig_0}F}\end{figure} \begin{figure}[htbp] \noindent\textbf{1} \par \begin{longtable}{P{0.85\textwidth}} 8.7\%).\\ 112 (2.1\%) of patients couldn't have chest x-ray\\ examination for several reasons. 1296 of the rest\\ (24.2\%) had normal, while 3952 (73.7\%) had abnormal\\ chest x-ray findings. Hereupon, 1984 patients (37\%)\\ undergone computered chest x-ray examination and\end{longtable} \par \caption{\label{tab_1}Table 1 :}\end{figure} \begin{figure}[htbp] \noindent\textbf{2} \par \begin{longtable}{P{0.6218926553672316\textwidth}P{0.10805084745762711\textwidth}P{0.12005649717514125\textwidth}} \multicolumn{2}{l}{requiring consultation}\tabcellsep \\ Departments\tabcellsep N\tabcellsep \%\\ Internal Medicine\tabcellsep 1480\tabcellsep 27.6\\ Surgery\tabcellsep 1160\tabcellsep 21.6\\ Otorhinolaryngeology\tabcellsep 216\tabcellsep 4.0\\ Urology\tabcellsep 544\tabcellsep 10.1\\ Microbiology and\tabcellsep 152\tabcellsep 2.8\\ Infectious Diseases\tabcellsep \tabcellsep \\ Neurology\tabcellsep 288\tabcellsep 5.4\\ Gynecology and\tabcellsep 120\tabcellsep 2.2\\ Obstetrics\tabcellsep \tabcellsep \\ Dermatology\tabcellsep 176\tabcellsep 3.3\\ Ophtalmology\tabcellsep 88\tabcellsep 1.6\\ Neurochirurgy\tabcellsep 136\tabcellsep 2.5\\ Anesthesiology and\tabcellsep 104\tabcellsep 1.9\\ Intensive Care\tabcellsep \tabcellsep \\ Emergency\tabcellsep 360\tabcellsep 6.7\\ Ortopedia and\tabcellsep 536\tabcellsep 10.0\\ Traumatology\tabcellsep \tabcellsep \\ Total\tabcellsep 5360\tabcellsep 100.0\end{longtable} \par \caption{\label{tab_2}Table 2 :}\end{figure} \begin{figure}[htbp] \noindent\textbf{3} \par \begin{longtable}{P{0.5076388888888889\textwidth}P{0.1534722222222222\textwidth}P{0.18888888888888888\textwidth}} Complaints\tabcellsep N\tabcellsep \%\\ None\tabcellsep 904\tabcellsep 16.9\\ Cough\tabcellsep 1000\tabcellsep 18.7\\ Dyspnea\tabcellsep 2200\tabcellsep 41.0\\ Hemoptysis\tabcellsep 32\tabcellsep 0.6\\ Chest pain\tabcellsep 64\tabcellsep 1.2\\ Cough and chest\tabcellsep 824\tabcellsep 15.4\\ pain\tabcellsep \tabcellsep \\ Other complaints\tabcellsep 336\tabcellsep 6.2\\ Total\tabcellsep 5360\tabcellsep 100.0\end{longtable} \par \caption{\label{tab_3}Table 3 :}\end{figure} \begin{figure}[htbp] \noindent\textbf{4} \par \begin{longtable}{P{0.2833333333333333\textwidth}P{0.5666666666666667\textwidth}} N\tabcellsep \%\end{longtable} \par \caption{\label{tab_4}Table 4 :}\end{figure} \footnote{© 2013 Global Journals Inc. (US)} \footnote{© 2013 Global Journals Inc. (US)} \backmatter \par (In Turkish).\par Evaluation \begin{bibitemlist}{1} \bibitem[T?p Fak Derg ()]{b1}\label{b1} \textit{}, S D T?p Fak Derg . 2005. 12 p. . (In Turkish) \bibitem[Numanoglu and Alper ()]{b10}\label{b10} ‘Ameliyat öncesi akci?er fonksiyonlar?n? de?erlendirme’. N Numanoglu , D Alper . \textit{Tüberküloz ve Toraks} 1990. 38 p. . \bibitem[Ucar et al. ()]{b8}\label{b8} ‘Atatürk Gö?üs Hastal?klar? ve Gö?üs Cerrahisi Merkezi'nden istenen gö?üs hastal?klar? konsültasyonlar?n?n de?erlendirilmesi’. N Ucar , S Alpar , G A Mutlu . \textit{Solunum Hastal?klar?} 2000. 11 p. . \bibitem[Ozlu ()]{b3}\label{b3} ‘Consultation in today's medicine: Review’. T Ozlu . \textit{Turkiye Klinikleri J Med Ethics} 2011. 19 (1) p. . \bibitem[Balbay et al. ()]{b6}\label{b6} ‘Devlet hastanesinde yata??nda istenen gö?üs hastal?klar? konsültasyonlar?’. 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Tüberküloz ve Toraks}, A Zamani . 1996. 44 p. . \bibitem[Singer ()]{b2}\label{b2} ‘Strengthening the role of ethics in medical education’. P A Singer . \textit{CMAJ} 2003. 1 (7) p. . \bibitem[Annakkaya et al. ()]{b5}\label{b5} ‘Yata??nda gö?üs hastal?klar? konsültasyonu’. A N Annakkaya , E Tozkoparan , O Deniz . \textit{Gülhane T?p Dergisi} 2005. 47 (1) p. . \end{bibitemlist} \end{document}