[A case of pulmonary sequestration presenting as solitary pulmonary nodule]. / Soliter pulmoner nodül olarak ortaya çikan bir pulmoner sekestrasyon olgusu.

Pulmonary sequestration is a rare, usually a cystic mass which is composed of nonfunctioning pulmonary tissue that does not communicate with the tracheobronchial tree. In computed tomography pulmonary sequestration is seen as usually a discrete mass lesion, with or without cystic changes, associated with local emphysematous areas located in lower lobes. We present a case of pulmonary sequestration located in apicoposterior segment of left upper lobe and presented as a solitary pulmonary nodule having smooth margins different from the classical radiological appearance of pulmonary sequestration.

Changes in platelet count and indices in pulmonary tuberculosis.

BACKGROUND: Recent studies show that platelets have important roles in the immune system. Little is known about the clinical significance of platelet indices. Changes in platelet indices, including platelet distribution width (PDW), mean platelet volume (MPV) and plateletcrit, in pulmonary tuberculosis were investigated. METHODS: Platelet indices were quantified in 82 patients with active tuberculosis and 87 patients with inactive or non-tuberculous disease (controls). Radiological extent of the disease was assessed. RESULTS: There were significantly higher PDW (40.9+/-23.5% vs. 27.0+/-14.5%), MPV (10.05+/-2.36 vs. 8.83+/-1.47 fL) and plateletcrit (0.330+/-0166% vs. 0.266+/-0.128%) values in the active tuberculosis group, which decreased significantly with anti-tuberculous therapy. Erythrocyte sedimentation rate and plateletcrit showed significant correlation (r=0.54 and r=0.66) with radiological extent of tuberculosis, while PDW and MPV correlations with radiological extent of tuberculosis were also significant but weaker (r=0.31 and r=0.23). In a subpopulation of controls with pneumonia, which leads to acute phase reaction, PDW, MPV and plateletcrit values were significantly lower than in the tuberculosis group. CONCLUSIONS: We suggest that PDW, MPV and plateletcrit change in tuberculosis and that these changes may not reflect only acute phase reaction and disease activity. The potential role of platelet indices in tuberculosis immunopathogenesis remains to be investigated.

Idiopathic pulmonary hemosiderosis in an adult patient responded well to corticosteroid therapy.

Idiopathic pulmonary hemosiderosis (IPH) is a very rare disorder of unknown etiology characterized by recurrent or chronic hemorrhage and accumulation of hemosiderin in the lung parenchyma. It is most common in children but can occur in adults. Clinical manifestations of the disease include iron deficiency anemia without any known cause, pulmonary symptoms such as hemoptysis, dyspnea and cough, and parenchymal lesions on chest X-ray. The clinical course of the disease may vary from patient to patient however, in general, the prognosis of the disease is worse. Treatment is symptomatic and supportive. Corticosteroids and other immune suppressive agents were used for the therapy of IPH. Since it is seen rarely in adults and the clinical course of the disease vary from patient to patient we presented an adult male patient with IPH responded well to steroid therapy clinically and radiologically.

Serum total cholesterol, HDL-C and LDL-C concentrations significantly correlate with the radiological extent of disease and the degree of smear positivity in patients with pulmonary tuberculosis.

BACKGROUND: Low serum total cholesterol (TC) concentrations in patients with pulmonary tuberculosis (PTB) have been demonstrated. It was shown that a cholesterol-rich diet might accelerate the sterilization rate of sputum cultures in PTB patients. It is known that smear positivity might be related to the radiological extent of disease (RED) in PTB patients. OBJECTIVE: We hypothesized that there might be a relationship between initial serum TC concentrations; the degree of RED (DRED) and the degree of smear positivity (DSP) in PTB patients. METHOD: Eighty-three PTB patients and 39 healthy controls were included in the study. Serum TC, TG, HDL-C, VLDL-C and LDL-C concentrations were determined in all subjects. PTB patients were classified for their chest X-ray findings as minimal/mild, moderate and advanced. Correlations between serum lipid concentrations, DRED and DSP (0, 1+, 2+, 3+, 4+) were investigated. PTB patients and controls were also compared for serum lipid concentrations. RESULTS: Significant differences between PTB patients and controls were detected for serum TC, HDL-C and LDL-C concentrations. On stepwise logistic regression analysis, DRED was found as one of the significant independent predictors of serum TC levels. We also found significant correlations between DRED and serum HDL-C concentrations (r=-0.60, p=0.0001) and between DRED and serum LDL-C concentrations (r=-0.28, p=0.011). There were also significant correlations between DSP and serum lipid concentrations. CONCLUSION: Our study suggests that serum TC, HDL-C and LDL-C concentrations are generally lower in patients with PTB than those in healthy controls. In addition, changes in these parameters might be related to DRED and DSP in PTB patients.

Serum HDL-C levels, log (TG/HDL-C) values and serum total cholesterol/HDL-C ratios significantly correlate with radiological extent of disease in patients with community-acquired pneumonia.

BACKGROUND: In several studies, it was shown that there was a marked decrease in serum levels of HDL-C during infection and inflammation in general. In particular, a decrease in the level of serum HDL-C was also shown in pneumonia. Correlations between inflammatory markers such as acute phase proteins, cytokines and serum HDL-C levels were shown. However, there are no studies indicating a correlation between serum HDL-C levels and the radiological extent of the disease (RED) in community-acquired pneumonia (CAP). AIM: We hypothesized that there could be a relationship between serum HDL-C levels and RED in CAP. MATERIALS AND METHODS: A case-controlled study, including 97 patients with CAP and 45 healthy subjects, was performed. Chest X-rays of CAP patients were scored for RED, and correlations were investigated between RED scores, serum lipid parameters, the erythrocyte sedimentation rate (ESR) and serum albumin levels. RESULTS: The mean serum HDL-C level was lower in CAP patients than in controls. A significant and negative correlation between RED scores (REDS) and serum HDL-C levels was detected (r = -0.64, P = 0.0001). There were also significant correlations between REDS and other lipid parameters. Significant correlations between ESR and serum HDL-C levels and between ESR and other serum lipid parameters were also found. CONCLUSION: It appears that serum HDL-C levels are generally lower in CAP cases than in healthy controls. Serum HDL-C levels and serum albumin levels might decrease and serum total cholesterol/HDL-C ratios and log (TG/HDL-C) values might increase proportionally with RED in CAP patients. These results might have some significance for individuals having long-standing and/or recurrent pneumonia and other cardiovascular risk factors.

[Poland syndrome (a case report)]. / Poland sendromu (olgu sunumu).

Poland syndrome is characterized with unilateral absence of pectoralis major muscle. Its incidence is one in 30000 live births. A 20 years old case with Poland syndrome is presented together with its clinical and laboratory features in this study. The case had anomaly of shortness of right hand fingers and syndactily between second and third fingers in addition to absence of right pectoralis muscle group. There was not another associated anomaly except aforementioned ones. Strength loss in abduction and adduction of right shoulder was detected with Cybex dynamometer. Furthermore decrease in predicted maximal inspiratory and expiratory pressures was detected.

High resolution computed tomographic features of pulmonary alveolar microlithiasis.

BACKGROUND: Pulmonary alveolar microlithiasis (PAM) is a rare, chronic lung disease with unknown etiology and with a nonuniform clinical course. Nonuniformity of clinical course might be related to the degree of pulmonary parenchymal alterations, which can be revealed with high resolution computed tomography (HRCT). However, HRCT findings of PAM were not fully described in the current literature. AIM: The aim of this study was to interpret and to contribute to describe HRCT findings of PAM and to investigate a correlation between profusion of micro nodules (MN) and pulmonary parenchymal alterations in patients with PAM. MATERIAL AND METHODS: Ten male patients with PAM (mean age: 22+/-3.2) were included into the study. HRCT images were assessed for patterns, distribution, and profusion of pulmonary abnormalities. Dividing the lungs into three zones, profusion of abnormalities was assessed. A profusion score (1-4) was given and the scores of each zone were then summed to obtain a global profusion score for HRCT ranging from 0 to 12. Also a parenchymal alteration score (PAS) was defined with respect to profusion of abnormalities. Chest X-rays were also scored. RESULTS: All of ten patients with PAM had findings of interstitial lung disease in varying degrees on their HRCTs. HRCT findings of patients with PAM were as following: MN, parenchymal bands (PB), ground glass opacity (GGO) and, sub pleural interstitial thickening (SPIT) in 10 patients; interlobular septal thickening (ILST), in 9 patients; paraseptal emphysema (PSA) in 8 patients; centrilobular emphysema (CLA) in 7 patients; bronchiectasis (BE), confluent micro nodules (CMN) in 6 patients; peri bronchovascular interstitial thickening (PBIT) in 5 patients; panacinar emphysema (PANAA) in 3 patients; pleural calcification (PC) in 2 patients. A significant correlation between MN scores and PAS (r=0.68, p=0.031, MN scores and GGO scores (r=0.69, p=0.027) and, MN scores and CLA scores (r=0.67, p=0.034) was detected. We also found significant correlations between HRCT scores and results of pulmonary function tests (PFTs), HRCT scores and chest X-ray score (CXRS) and, CXRS and results of PFTs. CONCLUSION: We conclude that patients with PAM may have all findings of interstitial lung disease in varying degrees as well as MNs on their HRCTs. More importantly, this study suggests a proportional relationship between profusion of MNs and parenchymal alterations in patients with PAM. This study also suggests that the degree of parenchymal alterations closely related with the degree of pulmonary function loss in patients with PAM.

Pleural fluid and serum procalcitonin as diagnostic tools in tuberculous pleurisy.

BACKGROUND: Diagnosis of tuberculous pleuritis is difficult because of its nonspecific clinical presentation and decreased efficiency of traditional diagnostic methods. We investigated the use of procalcitonin (PCT) concentration in tuberculous pleuritis diagnosis. METHODS: A prospective clinical study was performed with two different patient groups. A total of 28 patients were included: 18 with tuberculosis and 10 with nontuberculous pleurisy. Serum and pleural fluid PCT concentrations were evaluated before treatment. RESULTS: Serum and pleural fluid PCT concentrations were statistically different between tuberculous and nontuberculous pleurisy groups (P = 0.012 and P = 0.004, respectively), even though they were not elevated in relation to the cut-off level of 0.5 ng/mL. A positive and significant correlation was detected between serum and pleural fluid PCT levels (r = 0.49, P = 0.008). Diagnostic specificity and sensitivity values for serum and pleural fluid PCT in discriminating tuberculous from nontuberculous pleurisy were 80% and 72.2%, and 90% and 66.7% at the 0.081 and 0.113 ng/mL cut-off values, respectively. CONCLUSION: Relative to the current cut-off level of 0.5 ng/mL, PCT concentration is not a useful parameter for the diagnosis of tuberculous pleurisy. Because there were PCT levels in patients with tuberculous pleurisy that were below the current cut-off level but were significantly different from those of the nontuberculous group, the use of PCT should be further investigated.

[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.

[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.

[Symptomatic intracranial tuberculoma revealed when the patient receiving therapy for miliary tuberculosis: a case report]. / Miliyer tüberkülozun tedavisi sirasinda ortaya çikan semptomatik intrakranial tüberküloma: Bir olgu nedeniyle.

We describe a 20 year old man with miliary tuberculosis of the lung, who was noted to have multiple intracranial tuberculomas on magnetic resonance imaging but not noncontrast head computed tomographic scan receiving antituberculous chemotherapy.