{"id":658,"date":"2012-07-22T10:40:59","date_gmt":"2012-07-22T07:40:59","guid":{"rendered":"http:\/\/www.hvtd.org\/?p=658"},"modified":"2012-07-22T10:40:59","modified_gmt":"2012-07-22T07:40:59","slug":"pilotlarda-bobrek-tasi-problemi","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=658","title":{"rendered":"Pilotlarda B\u00f6brek Ta\u015f\u0131 Problemi"},"content":{"rendered":"
\n

\"\"<\/a>B\u00f6brek ta\u015flar\u0131 pilotaj muayenelerinde zaman zaman kar\u015f\u0131la\u015f\u0131lan ve \u00fcrologlar\u0131n sertifikasyon verirken zorluk ya\u015fad\u0131klar\u0131 bir durumdur. Hatta bunun koroner arter ve atrial fibrilasyon hastal\u0131klar\u0131ndan daha zor bir karar oldu\u011fu ileri s\u00fcr\u00fclm\u00fc\u015ft\u00fcr. Ta\u015f\u0131n lokalizasyonu ve b\u00fcy\u00fckl\u00fc\u011f\u00fc, ge\u00e7mi\u015f renal kolik ve ameliyat \u00f6yk\u00fcs\u00fc, pasaj\u0131 engelleme-hidronefroz geli\u015fimi, enfeksiyon vb. gibi \u00f6zelliklerine bakarak baz\u0131 \u00f6ng\u00f6r\u00fclerde bulunulabilirse de, koli\u011fin ne zaman ba\u015flayaca\u011f\u0131n\u0131 kestirmek m\u00fcmk\u00fcn de\u011fildir. Karar verme zorlu\u011funun dayand\u0131\u011f\u0131 ikilem \u015fudur: Kuramsal olarak a\u011fr\u0131 ortaya \u00e7\u0131kt\u0131\u011f\u0131nda pilotu inkapasite hale getirecektir ve bu olas\u0131l\u0131k y\u00fcz\u00fcnden u\u00e7u\u015f vermek sak\u0131ncal\u0131 gibi g\u00f6r\u00fcn\u00fcr; ancak a\u011fr\u0131n\u0131n belki aylar veya y\u0131llar sonra bile ortaya \u00e7\u0131kmayabilece\u011fi olas\u0131l\u0131\u011f\u0131 da s\u00f6z konusudur ve bu y\u00fczden de hi\u00e7bir i\u015flevsel yetersizli\u011fi olmayan bir pilotun u\u00e7u\u015funu kesmek mant\u0131kl\u0131 say\u0131lmaz. Zaten sivil pilotlar\u0131n baz\u0131lar\u0131, zorunlu muayene zaman\u0131 gelinceye kadar durumunu bildirmekten imtina ederler.<\/p>\n

\u0130ngiltere\u2019de genel pop\u00fclasyonda b\u00f6brek ta\u015f\u0131 oran\u0131 %2 olup, \u00e7a\u011fda\u015f diyet al\u0131\u015fkanl\u0131klar\u0131 bu oran\u0131 artt\u0131rmaktad\u0131r. Erkeklerde bayanlara g\u00f6re 3 kat fazlad\u0131r. U\u00e7ucu grubundaki oranlar\u0131n da bu civarda oldu\u011fu s\u00f6ylenebilir. Ancak pilotlarda ta\u015f olu\u015fumunu artt\u0131rabilece\u011fi varsay\u0131lan birka\u00e7 unsura dikkat \u00e7ekilmi\u015ftir: \u00d6zellikle askeri pilotlar gerek kokpit ortam\u0131n\u0131n s\u0131cakl\u0131\u011f\u0131na ve gerekse dar ve kal\u0131n u\u00e7u\u015f giysilerinin yaratt\u0131\u011f\u0131 terlemeye (dehidrasyona) maruz kalmakta, her ihtiya\u00e7 duydu\u011funda s\u0131v\u0131 alamamakta ve tuvalete gidememekte olan ki\u015filerdir. Ayn\u0131 risk gemilerin kazan dairelerinde ve mutfaklar\u0131nda \u00e7al\u0131\u015fan personelde de y\u00fcksek bulunmu\u015ftur. Genetik yatk\u0131nl\u0131k ve oturarak i\u015f g\u00f6rmek gibi unsurlardan da s\u00f6z edilebilirse de, dehidrasyon hipotezini destekleyen bir ba\u015fka bulgu, b\u00f6brek ta\u015flar\u0131n\u0131n \u00e7o\u011funlukla yaz aylar\u0131nda olu\u015ftu\u011fudur. Kuzey yar\u0131mk\u00fcrede hazirandan eyl\u00fcle kadar olan yaz aylar\u0131nda, g\u00fcney yar\u0131mk\u00fcrede (Avustralya\u2019daki yaz mevsimi) aral\u0131k-mart aylar\u0131nda ta\u015f olgular\u0131n\u0131n artt\u0131\u011f\u0131 bilinmektedir. Uzun uzay u\u00e7u\u015flar\u0131nda plazma vol\u00fcm\u00fcn\u00fcn azalmas\u0131, serum osmolaritesinin, sodyumun ve ADH\u2019nin artmas\u0131 g\u00f6r\u00fclmekte, bu da b\u00f6brek ta\u015f\u0131 riskini artt\u0131rmaktad\u0131r.<\/p>\n

Havac\u0131l\u0131k t\u0131bb\u0131 literat\u00fcr\u00fcnde b\u00f6brek ta\u015f\u0131 koli\u011fine ba\u011fl\u0131 inkapasitasyon olgu raporlar\u0131 \u00e7ok bol de\u011fildir; 1960-66 periyodunu kapsayan bir IATA raporunda 42 inkapasitasyon olgusunun sadece 4\u2019\u00fcn\u00fcn renal koli\u011fe ba\u011fl\u0131 oldu\u011fu ve \u00f6l\u00fcmc\u00fcl bir kazayla sonu\u00e7lanmad\u0131\u011f\u0131 bildirilmektedir. ABD Kara K. u\u00e7ucular\u0131nda 1984-87 aras\u0131ndaki taramada binde 4.7 oran\u0131nda g\u00f6r\u00fclm\u00fc\u015f, ta\u015f olgular\u0131n\u0131n %85\u2019i 25-44 ya\u015f grubunda toplanm\u0131\u015ft\u0131r. Ancak u\u00e7u\u015f stat\u00fcs\u00fcn\u00fc kaybetmemek i\u00e7in baz\u0131 havac\u0131lar\u0131n rahats\u0131zl\u0131klar\u0131n\u0131 bildirmedikleri veya sistem d\u0131\u015f\u0131ndaki hekimlere ba\u015fvurduklar\u0131 da herkesin bildi\u011fi bir s\u0131rd\u0131r.<\/p>\n

Askeri havac\u0131l\u0131kta ilk pilotaj muayenesinde ta\u015f tespit edilen ve ge\u00e7mi\u015finde kolik \u00f6yk\u00fcs\u00fc olan adaylar u\u00e7u\u015fa kabul edilmezler. Sivil havac\u0131l\u0131kta b\u00f6brek ta\u015f\u0131 veya koli\u011fi olan u\u00e7ucular\u0131n u\u00e7u\u015fu kesilir ve \u00fcrografik tetkike g\u00f6nderilerek \u00fcriner sistemde fonksiyon bozuklu\u011fu veya komplikasyon olup olmad\u0131\u011f\u0131 ara\u015ft\u0131r\u0131l\u0131r; normalse ve ta\u015f d\u00fc\u015f\u00fcr\u00fclm\u00fc\u015f veya al\u0131nm\u0131\u015f olup pasaj a\u00e7\u0131lm\u0131\u015fsa u\u00e7u\u015f verilebilir. Bu durumda, birden fazla kumandal\u0131 u\u00e7ak pilotlar\u0131n\u0131n y\u0131lda bir, askeri havac\u0131l\u0131kta ise 6 ayda bir kontrol\u00fc \u00f6nerilir. S\u0131k tekrarlayan ta\u015f olgular\u0131 u\u00e7u\u015ftan ay\u0131r\u0131l\u0131r.<\/p>\n

Bol s\u0131v\u0131 al\u0131m\u0131, y\u00fcksek oksalat i\u00e7eren g\u0131dalardan ka\u00e7\u0131n\u0131lmas\u0131, \u00fcrat ta\u015f\u0131 olanlar\u0131n allop\u00fcrinol<\/em> kullanmas\u0131 \u00f6nerilmektedir. Keza, tiazid ve sitrat kullan\u0131m\u0131n\u0131n ta\u015f olu\u015fumunu inhibe etti\u011fi, u\u00e7ucu grupta tiazid\u2019in sak\u0131ncal\u0131 oldu\u011fu ve sitrat\u0131n tercih edilmesi gerekti\u011fi ileri s\u00fcr\u00fclm\u00fc\u015ft\u00fcr. Rezid\u00fcel ta\u015f olgular\u0131nda, cerrahi yakla\u015f\u0131mlardan \u00f6nce litotripsi (ESWL), denenmesi gereken en uygun yoldur.
\nKaynaklar:<\/strong><\/p>\n

1. Navathe PD, Drane M, et al. Aeromedical decision making in renal calculi. 78th Annual AsMA Scientific Meeting (2007) Abs.# 534<\/p>\n

2. Rainford DJ. Renal disease and hypertension. In: Aviation Medicine. Eds: Ernsting J, Nicholson AN, Davis JR. 3rd Edit. Butterworth Heinemann, 1999 p. 293-6<\/p>\n

3. DeHart RL. Selected medical and surgical conditions of aeromedical concern. In: Fundamentals of Aerospace
\nMedicine. Eds: DeHart RL, Davis JR. 3rd Edit, Lippincott Williams&Wilkins Philadelphia 2002. p.450<\/p>\n

4. Clark JY. Renal calculi in army aviators. Aviat Space Environ Med. 1990;61: 744-7<\/p>\n

Haz\u0131rlayan :<\/strong> Do\u00e7. Dr. Muzaffer \u00c7eting\u00fc\u00e7<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

B\u00f6brek ta\u015flar\u0131 pilotaj muayenelerinde zaman zaman kar\u015f\u0131la\u015f\u0131lan ve \u00fcrologlar\u0131n sertifikasyon verirken zorluk ya\u015fad\u0131klar\u0131 bir durumdur. Hatta bunun koroner arter ve atrial fibrilasyon hastal\u0131klar\u0131ndan daha zor bir karar oldu\u011fu ileri s\u00fcr\u00fclm\u00fc\u015ft\u00fcr. Ta\u015f\u0131n lokalizasyonu ve b\u00fcy\u00fckl\u00fc\u011f\u00fc, ge\u00e7mi\u015f renal kolik ve ameliyat \u00f6yk\u00fcs\u00fc, pasaj\u0131 engelleme-hidronefroz geli\u015fimi, enfeksiyon vb. gibi \u00f6zelliklerine bakarak baz\u0131 \u00f6ng\u00f6r\u00fclerde bulunulabilirse de, koli\u011fin ne zaman ba\u015flayaca\u011f\u0131n\u0131 kestirmek m\u00fcmk\u00fcn de\u011fildir. Karar […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[6],"tags":[],"class_list":["post-658","post","type-post","status-publish","format-standard","hentry","category-bulten"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/658","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=658"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/658\/revisions"}],"predecessor-version":[{"id":660,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/658\/revisions\/660"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=658"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=658"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=658"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}