Turkiye Klinikleri Archives of Lung

.: ORIGINAL RESEARCH
Primer Spontan Pnömotoraksta İlk Epizot Sonrası Nüksü Öngörmede Etkili Risk Faktörleri: Tanımlayıcı Çalışma
Risk Factors for Predicting Recurrence After the First Episode of Primary Spontaneous Pneumothorax: Descriptive Study
Hıdır ESMEa
aSağlık Bilimleri Üniversitesi Konya Şehir Hastanesi, Göğüs Cerrahi Kliniği, Konya, Türkiye
Turkiye Klinikleri Arch Lung. 2024;23(2):31-5
doi: 10.5336/archlung.2024-105789
Article Language: TR
Full Text
ÖZET
 Amaç: Primer spontan pnömotoraksın (PSP) ilk atağından sonra, ortalama nüks oranı %30 olarak rapor edilmiştir. Çocuklarda bu oran %50 ila %60 arasında görünmektedir. Bu çalışmanın amacı, ilk atak sonrası nüksün önlenmesi için cerrahi tedaviden fayda görebilecek hastaların seçiminde yararlı olabilecek nüks öngörücü faktörlerin belirlenmesidir. Gereç ve Yöntemler: Çalışmaya, Ağustos 2020 ile Haziran 2023 tarihleri arasında göğüs cerrahi kliniğimizde PSP nedeniyle yatarak tedavi uygulanan 112 hasta dâhil edildi. Tüm hastaların yaş, cinsiyet, boy, ağırlık, beden kitle indeksi, sigara içme öyküsü, pnömotoraks tarafı, pnömotoraksın miktarı, toraks bilgisayarlı tomografi (BT) bulguları ve uygulanan tedavi yöntemleri kaydedildi. Bulgular: Ortalama yaş 21,1±1,7 (14-34) yıldı. Hastaların 93'ü (%83) erkekti. Toraks BT değerlendirmesinde distrofik şiddet skoru 60 (%53,5) hastada sıfır iken, 21 (%18,7) hastada düşük değerli, 31 (%27,6) hastada ise yüksek değerdeydi. Nüks gelişimi ile sigara kullanımı (p=0,035), pnömotoraks miktarı (p=0,003) ve toraks BT'de distrofik şiddet skoru (p=0,024) arasında istatistiksel olarak anlamlı fark vardı. Nüks gelişimi ile yaş (p=0,065), cinsiyet (p=0,145), boy (p=0,895), beden kitle indeksi (p=0,123), pnömotoraks tarafı (p=0,768) ve tedavi şekli (p=0,540) arasında istatistiksel olarak anlamlı ilişki yoktu. Sonuç: PSP'nin ilk atağında sigara içme hikayesi, yüksek pnömotoraksın miktarı ve BT'de yüksek dereceli distrofik şiddet skoru, ipsilateral nüks gelişimi ile önemli ölçüde ilişkiliydi. Risk faktörleri daha ileri çalışmalarla netleştirilirse, erken video yardımlı toraks cerrahi ile hastanede kalış süreleri ve PSP nüksü azaltılabilir.

Anahtar Kelimeler: Primer spontan pnömotoraks; nüks; risk faktörleri
ABSTRACT
 Objective: The average recurrence rate after the first episode of primary spontaneous pneumothorax (PSP) has been reported to be 30%. In children, this rate appears to be between 50% and 60%. The aim of this study was to identify predictive factors for recurrence that may be useful in selecting patients who may benefit from surgical treatment to prevent recurrence after the first episode. Material and Methods: The study included 112 patients who underwent inpatient treatment for PSP in our thoracic surgery clinic between August 2020 and June 2023. Age, sex, height, weight, body mass index, smoking history, side of pneumothorax, amount of pneumothorax, chest computed tomography (CT) findings, and treatment modalities were recorded. Results: Mean age was 21.1±1.7 (14-34) years. 93 (83%) of the patients were male. The dystrophic severity score was zero in 60 patients (53.5%), low in 21 patients (18.7%), and high in 31 patients (27.6%). There was a statistically significant difference between the development of recurrence and smoking (p=0.035), the amount of pneumothorax (p=0.003), and the dystrophic severity score on chest CT (p=0.024). There was no statistically significant correlation between recurrence and age (p=0.065), gender (p=0.145), height (p=0.895), body mass index (p=0.123), side of pneumothorax (p=0.768) and treatment modality (p=0.540). Conclusion: A history of smoking at the first episode of PSP, a high amount of pneumothorax and a high grade dystrophic severity score on CT were significantly associated with the development of ipsilateral recurrence. If the risk factors are clarified by further studies, early video assisted thoracoscopic surgery may reduce the length of hospital stay and PSP recurrence.

Keywords: Primary spontaneous pneumothorax; recurrence; risk factors
REFERENCES:
  1. Pessoa-Gonçalves YM, Silva ACVE, Oliveira CJF, Adad SJ, Guimarães LC. Primary spontaneous pneumothorax. Autops Case Rep. 2024;14:e2023468. [Crossref]  [PubMed]  [PMC] 
  2. Sauter JL, Butnor KJ. Pathological findings in spontaneous pneumothorax specimens: does the incidence of unexpected clinically significant findings justify routine histological examination? Histopathology. 2015;66(5):675-84. [Crossref]  [PubMed] 
  3. Bintcliffe OJ, Hallifax RJ, Edey A, Feller-Kopman D, Lee YC, Marquette CH, et al. Spontaneous pneumothorax: time to rethink management? Lancet Respir Med. 2015;3(7):578-88. [Crossref]  [PubMed] 
  4. Khan OA, Tsang GM, Barlow CW, Amer KM. Routine histological analysis of resected lung tissue in primary spontaneous pneumothorax -- is it justified? Heart Lung Circ. 2006;15(2):137-8. [Crossref]  [PubMed] 
  5. Grundy S, Bentley A, Tschopp JM. Primary spontaneous pneumothorax: a diffuse disease of the pleura. Respiration. 2012;83(3):185-9. [Crossref]  [PubMed] 
  6. Noppen M. Spontaneous pneumothorax: epidemiology, pathophysiology and cause. Eur Respir Rev. 2010;19(117):217-9. [Crossref]  [PubMed]  [PMC] 
  7. Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med. 2000;342(12):868-74. [Crossref]  [PubMed] 
  8. Butterworth SA, Blair GK, LeBlanc JG, Skarsgard ED. An open and shut case for early VATS treatment of primary spontaneous pneumothorax in children. Can J Surg. 2007;50(3):171-4. [PubMed]  [PMC] 
  9. Cook CH, Melvin WS, Groner JI, Allen E, King DR. A cost-effective thoracoscopic treatment strategy for pediatric spontaneous pneumothorax. Surg Endosc. 1999;13(12):1208-10. [Crossref]  [PubMed] 
  10. Poenaru D, Yazbeck S, Murphy S. Primary spontaneous pneumothorax in children. J Pediatr Surg. 1994;29(9):1183-5. [Crossref]  [PubMed] 
  11. Qureshi FG, Sandulache VC, Richardson W, Ergun O, Ford HR, Hackam DJ. Primary vs delayed surgery for spontaneous pneumothorax in children: which is better? J Pediatr Surg. 2005;40(1):166-9. [Crossref]  [PubMed] 
  12. Seguier-Lipszyc E, Elizur A, Klin B, Vaiman M, Lotan G. Management of primary spontaneous pneumothorax in children. Clin Pediatr (Phila). 2011;50(9):797-802. [Crossref]  [PubMed] 
  13. Casali C, Stefani A, Ligabue G, Natali P, Aramini B, Torricelli P, et al. Role of blebs and bullae detected by high-resolution computed tomography and recurrent spontaneous pneumothorax. Ann Thorac Surg. 2013;95(1):249-55. [Crossref]  [PubMed] 
  14. Ozcan C, McGahren ED, Rodgers BM. Thoracoscopic treatment of spontaneous pneumothorax in children. J Pediatr Surg. 2003;38(10):1459-64. [Crossref]  [PubMed] 
  15. Brown SG. Pleurodesis for primary spontaneous pneumothorax. Lancet. 2013;382(9888):203. [Crossref]  [PubMed] 
  16. Vuong NL, Elshafay A, Thao LP, Abdalla AR, Mohyeldin IA, Elsabaa K, et al. Efficacy of treatments in primary spontaneous pneumothorax: A systematic review and network meta-analysis of randomized clinical trials. Respir Med. 2018;137:152-66. [Crossref]  [PubMed] 
  17. Bialas RC, Weiner TM, Phillips JD. Video-assisted thoracic surgery for primary spontaneous pneumothorax in children: is there an optimal technique? J Pediatr Surg. 2008;43(12):2151-5. [Crossref]  [PubMed] 
  18. Chung PH, Wong KK, Lan LC, Tam PK. Thoracoscopic bullectomy for primary spontaneous pneumothorax in pediatric patients. Pediatr Surg Int. 2009;25(9):763-6. [Crossref]  [PubMed] 
  19. Choi SY, Kim YH, Jo KH, Kim CK, Park JK, Cho DG, et al. Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in children. Pediatr Surg Int. 2013;29(5):505-9. [Crossref]  [PubMed] 
  20. Chambers A, Scarci M. In patients with first-episode primary spontaneous pneumothorax is video-assisted thoracoscopic surgery superior to tube thoracostomy alone in terms of time to resolution of pneumothorax and incidence of recurrence? Interact Cardiovasc Thorac Surg. 2009;9(6):1003-8. [Crossref]  [PubMed] 
  21. Herrmann D, Klapdor B, Ewig S, Hecker E. Initial management of primary spontaneous pneumothorax with video-assisted thoracoscopic surgery: a 10-year experience. Eur J Cardiothorac Surg. 2016;49(3):854-9. [Crossref]  [PubMed] 
  22. Schnell J, Beer M, Eggeling S, Gesierich W, Gottlieb J, Herth FJF, et al. Management of spontaneous pneumothorax and post-ınterventional pneumothorax: German S3 guideline. Respiration. 2019;97(4):370-402. [Crossref]  [PubMed] 
  23. Nathan N, Guilbert J, Larroquet M, Lenoir M, Clement A, Epaud R. Efficacy of blebs detection for preventive surgery in children's idiopathic spontaneous pneumothorax. World J Surg. 2010;34(1):185-9. [Crossref]  [PubMed] 
  24. Huang TW, Lee SC, Cheng YL, Tzao C, Hsu HH, Chang H, et al. Contralateral recurrence of primary spontaneous pneumothorax. Chest. 2007;132(4):1146-50. [Crossref]  [PubMed] 
  25. Choudhary AK, Sellars ME, Wallis C, Cohen G, McHugh K. Primary spontaneous pneumothorax in children: the role of CT in guiding management. Clin Radiol. 2005;60(4):508-11. [Crossref]  [PubMed] 
  26. Martínez-Ramos D, Angel-Yepes V, Escrig-Sos J, Miralles-Tena JM, Salvador-Sanchís JL. Utilidad de la tomografía computarizada para determinar el riesgo de recidiva tras un primer episodio de neumotórax espontáneo primario. Implicaciones terapéuticas [Usefulness of computed tomography in determining risk of recurrence after a first episode of primary spontaneous pneumothorax: therapeutic implications]. Arch Bronconeumol. 2007;43(6):304-8. Spanish. [Crossref]  [PubMed] 
  27. Laituri CA, Valusek PA, Rivard DC, Garey CL, Ostlie DJ, Snyder CL, et al. The utility of computed tomography in the management of patients with spontaneous pneumothorax. J Pediatr Surg. 2011;46(8):1523-5. [Crossref]  [PubMed] 
  28. Robinson PD, Cooper P, Ranganathan SC. Evidence-based management of paediatric primary spontaneous pneumothorax. Paediatr Respir Rev. 2009;10(3):110-7; quiz 117. [Crossref]  [PubMed] 
  29. O'Lone E, Elphick HE, Robinson PJ. Spontaneous pneumothorax in children: when is invasive treatment indicated? Pediatr Pulmonol. 2008;43(1):41-6. [Crossref]  [PubMed] 
  30. Ouanes-Besbes L, Golli M, Knani J, Dachraoui F, Nciri N, El Atrous S, et al. Prediction of recurrent spontaneous pneumothorax: CT scan findings versus management features. Respir Med. 2007;101(2):230-6. [Crossref]  [PubMed] 
  31. Mitlehner W, Friedrich M, Dissmann W. Value of computer tomography in the detection of bullae and blebs in patients with primary spontaneous pneumothorax. Respiration. 1992;59(4):221-7. [Crossref]  [PubMed] 
  32. Warner BW, Bailey WW, Shipley RT. Value of computed tomography of the lung in the management of primary spontaneous pneumothorax. Am J Surg. 1991;162(1):39-42. Erratum in: Am J Surg 1992;163(6):635. [Crossref]  [PubMed] 
  33. Bense L, Eklund G, Wiman LG. Smoking and the increased risk of contracting spontaneous pneumothorax. Chest. 1987;92(6):1009-12. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com