The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study.

BACKGROUND: We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings. METHODS: A multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated. RESULTS: A total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT. CONCLUSION: CXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series.

Serum lactate dehydrogenase levels significantly correlate with radiological extent of disease and spirometric values in patients with silicosis due to denim sandblasting.

BACKGROUND: The aim of the present study was to investigate serum lactate dehydrogenase (LD) levels in patients with silicosis due to denim sandblasting (SDDS) and also to investigate possible correlations between serum LD levels and the degree of radiological extent of disease (RED) and pulmonary function tests. METHODS: Forty-four males with SDDS and 32 healthy male subjects were included in the study. Patients and healthy controls were compared for serum LD levels. Correlations between serum LD levels, RED and spirometric values were investigated. RESULTS: Patients with SDDS had significantly higher serum LD levels than healthy controls. Patients with complicated SDDS had significantly higher serum LD levels than patients with simple SDDS. Significant correlations were found between serum LD levels and RED values. Significant correlations were found between serum LD levels and spirometric parameters. CONCLUSIONS: High serum LD levels might be considered as a marker of pulmonary parenchymal involvement in patients with SDDS. This study also suggests that the increase in serum LD levels might be closely related to the degree of pulmonary involvement in SDDS patients.

[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.

Serum prolidase activity in patients with pulmonary tuberculosis.

AIM: To investigate serum prolidase activity (SPA) in patients with pulmonary tuberculosis (PTB). MATERIAL AND METHODS: Twenty-nine PTB patients and 32 controls were included in the study. PTB patients (cavitary and non-cavitary) and controls were compared in terms of mean SPA. Correlations were evaluated between SPA and acute phase reactants. RESULTS: Mean SPA was significantly higher in PTB patients than in the control group. Mean SPA was significantly higher in patients with cavitary TB than non-cavitary TB. Mean SPA in patients with mild PTB was lower than patients with moderate and severe disease. We found significant correlations between SPA and CRP, ESR, albumin, platelet counts, HDL-cholesterol and LDH activity. CONCLUSION: This study has shown that PTB patients have higher SPA than controls. The increase in SPA might be related to tissue destruction, increased immunoglobulin, complement levels and increased fibroblastic activity; all of which are involved in the natural history of PTB.

Effect of nail polish and henna on oxygen saturation determined by pulse oximetry in healthy young adult females.

OBJECTIVE: The purpose of this study was to determine the effect of different colour nail polishes and henna on the measurement of oxygen saturation and the differences among the measurements of three pulse oximetry devices. MATERIAL AND METHODS: 33 healthy females with a mean age of 19±1.0 years and no complaints or known disease were included into the study. All the participants applied henna to one of their fingers a day before the study. Just before the study, one finger was left empty as control and the other fingers were dyed using various colours of nail polish (red, blue, beige, purple, brown, white, pink, green, colourless polish, light blue, light green and yellow). There were more than eight colour nail polishes and some fingers were used for the other colours after being completely cleaned. The same brand nail polishes were used for the study. Oxygen saturation measurements were done using three different pulse oximetry devices (device I, II, III) from the control, different colour nail polished and henna applied fingers. The measurements of different devices, different colour nail polishes, henna and control were statistically compared. RESULTS: The mean saturations obtained from blue, beige, purple and white nail polished fingers were significantly lower than those of control and the other coloured fingers. In addition, the mean measurement of device II was significantly lower than those of other devices. CONCLUSION: The results suggest that blue, beige, purple and white nail polished fingers might cause pulse oximetry devices to make incorrect measurements.

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.

High-resolution CT findings in patients with pulmonary tuberculosis: correlation with the degree of smear positivity.

BACKGROUND: There are data about the relationship between morphologic findings on high-resolution computed tomography (HRCT) and the number of acid-fast bacilli (AFB) on sputum smears in patients with pulmonary tuberculosis (PTB). It was also shown that existence of cavities and airspace consolidation might be related to smear positivity in PTB patients. However, there is no study suggesting a relationship between AFB on sputum smears and radiologic extent of disease based on HRCT findings. AIM: In this study, we investigated a relationship between the degree of smear positivity and radiologic extent of disease based on HRCT findings and, the degree of smear positivity and different pulmonary parenchymal changes on HRCTs of the PTB patients. METHODS: Sixty-one male patients with PTB (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 3 zones, profusion of abnormalities was assessed. A profusion score was given. Patients were divided as smear positive and smear negative and compared for the scores of HRCT findings. Smear-positive patients were divided into 4 groups as per grading of the sputum AFB smear: group I (sputum 1+), group II (sputum 2+), group III (sputum 3+), and group IV (sputum 4+). Correlations were investigated between the degree of smear positivity and the scores of HRCT findings. RESULTS: A significant correlation between radiologic extent of the disease based on HRCT and the degree of smear positivity was found (r=0.63, P=0.0001). There were also significant correlations between the degree of smear positivity and the scores of different HRCT findings. Nodule, cavity, and bronchial lesions are the most important contributors of the predictive properties of the total score. There was significant differences for the scores of HRCT findings between smear-positive and smear-negative patients. CONCLUSIONS: Our study suggests that radiologic extent of disease based on HRCT findings in patients with PTB correlated with the degree of smear positivity. Different HRCT findings such as nodule, cavitation, ground-glass opacity, consolidation, and bronchial lesion are significantly associated with smear-positive PTB. Particularly, nodules, cavities, and bronchial lesions might be predictors of smear positivity in patients with PTB. This study also suggests that the thickness of cavity wall and the distance of cavity from central airways might be related to the degree of smear positivity.

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 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.

Assessment of the role of serum ischemia-modified albumin in obstructive sleep apnea in comparison with interleukin-6.

OBJECTIVES: There is limited and contradictory information regarding the role of serum ischemia-modified albumin (IMA) in obstructive sleep apnea (OSA). In this study we examine the effects of OSA and obesity on IMA and interleukin-6 (IL-6), and detect whether IMA and IL-6 may be potential biomarkers in OSA. METHODS: Fifty-one males who underwent all night polysomnography test were included into the study. Body-mass index (BMI) and apnea-hypopnea index (AHI) of all patients were determined. Serum IMA and IL-6 levels, erythrocyte sedimentation rate (ESR), complete blood count, routine blood biochemistry and thyroid function tests were performed. RESULTS: Mean IMA [0.36 (± 0.04) U/ml, 0.89 (± 0.15) U/ml], mean IL-6 [1.01 (± 0.19) pg/ml, 2.02 (± 1.19) pg/ml] and mean ESR [4.14 (± 2.5) mm/h, 14.35 (± 13.7) mm/h] levels showed significant difference between non-OSA and OSA groups (P = 0.005, P < 0.001, P < 0.001, respectively). Sensitivity of IMA in distinction of non-OSA/OSA was equal to IL-6 and higher than ESR. IMA was also a stronger predictive factor than IL-6 and ESR in the evaluation of OSA groups (severe/mild/moderate OSA and non-OSA). IMA was the sole distinctive biomarker in assessment of obese and non-obese cases. IMA correlated with IL-6, AHI and ESR. CONCLUSION: Serum IMA may be a valuable oxidative stress indicator for OSA and could act as a better biomarker than IL-6 for reflecting the presence and the severity of OSA.

Comparison of the clinical features and hematopoietic stem cell transplantation outcomes of mediastinal malignant germ cell tumors with nonmediastinal extragonadal placements.

OBJECTIVE: Even though the primary mediastinal extragonadal germ cell tumors (EGCTs) are rare, they are noteworthy in the differential diagnosis of mediastinal masses. In this study, we aimed to identify the clinical features of mediastinal malignant GCTs and compare the results of hematopoietic stem cell transplantation between mediastinal and nonmediastinal malignant EGCTs. METHOD: Data of the patients with EGCT who were treated and underwent hematopoietic stem cell transplantation at our hospital between 1988 and 2015 were retrieved retrospectively. Results were compared between mediastinal and nonmediastinal EGCTs. RESULTS: Data of 65 patients diagnosed with EGCT (37 [56.92%] cases with mediastinal EGCT and 28 [43.07%] cases with nonmediastinal EGCT) were assessed. The clinical stages, frequency of pretransplant status, mean pretransplant time, and mean number of chemotherapy lines before hematopoietic stem cell transplantation were not significantly different between groups. Although the overall survival did not significantly differ between groups, the 5-year survival was significantly higher in mediastinal EGCTs (P=0.02). Yolk sac tumor was significantly more common in mediastinal EGCTs (P=0.05). Mortality rates were higher in seminomas and yolk sac tumors in all cases, higher in embryonal carcinomas in mediastinal EGCT group and higher in yolk sac tumors in nonmediastinal EGCT group. While choriocarcinomas had more aggressive courses in mediastinal EGCTs, seminomas and yolk sac tumors had poorer prognosis in nonmediastinal EGCTs. Short pretransplant time and persistence of elevated posttransplant ßhCG and AFP levels were the significant mortality risk factors both in mediastinal and nonmediastinal EGCTs. CONCLUSION: Mediastinal placement of EGCT was not a poor prognostic factor; furthermore, the 5-year survival was significantly higher in mediastinal EGCTs. According to our knowledge, this is the first study that compares the clinical outcomes of hematopoietic stem cell transplantation of mediastinal and nonmediastinal malignant EGCTs.

Effects of hyperbaric oxygen treatment on liver functions, oxidative status and histology in septic rats.

OBJECTIVE: The liver is thought to be responsible for multiple organ failure during sepsis. Increase in tissue oxygen consumption is a major component of the septic response. Hyperbaric oxygen (HBO) therapy provides more oxygenation in the whole body. This study examined the effect of HBO alone or in combination with cefepime (CEF) on the liver in septic rats. DESIGN AND INTERVENTIONS: We divided 90 male rats into six groups; control, HBO, sepsis (SEP), SEP+HBO, SEP+CEF, and SEP+CEF+HBO. Sepsis was induced with an intraperitoneal injection of Escherichia coli (2.1 x 10(9) cfu). A total of six HBO sessions were performed at 2 atm absolute for 90 min at 6-h intervals. CEF was administered intraperitoneally at a dose of 50 mg/kg twice daily. Animals were killed 48 h after sepsis induction. Their liver and blood were removed for biochemical and histopathological analysis. MEASUREMENTS AND RESULTS: Liver thiobarbituric acid reactive substances as well as serum alanine transaminase, aspartate transaminase and alkaline phosphatase levels increased while the activity of the antioxidant enzymes superoxide dismutase and catalase decreased significantly in septic rats. These parameters returned to nearly control levels in the SEP+CEF+HBO group. Histological observations supported these findings: Hepatocellular degeneration was observed and intensive polymorphonuclear cell infiltration appeared in all fields of septic animal livers. HBO alone could not sufficiently reverse these histopathological changes, but most liver sections presented normal histology when it was combined with CEF. CONCLUSIONS: HBO may be a useful adjuvant therapy modality to improve the efficacy of sepsis treatment.

Correlation between hyperbaric oxygen exposure pressures and oxidative parameters in rat lung, brain, and erythrocytes.

OBJECTIVES: The oxygen toxicity risk of hyperbaric oxygen (HBO) treatment has long been of interest. However, there are no comprehensive articles describing the relationship between HBO protocols and oxidative parameters used clinically. The purpose of this study was to determine the effects of various HBO pressure modalities on the oxidative values of rat lung, brain, and erythrocytes. DESIGN AND METHODS: A total of 64 male Sprague-Dawley rats was randomly divided into 7 groups. Group A was used as a control. Groups C to G were subjected to 100% oxygen at a pressure of 1, 1.5, 2, 2.5, and 3 ATA (atmosphere absolute), respectively, for 2 h. Group B was exposed to normal atmospheric air at 3 ATA for the same duration. The rat's lung, brain, and blood were taken immediately after the exposure and thiobarbituric acid reactive substances (TBARS) and superoxide dismutase (SOD) levels were determined. RESULTS: Both TBARS levels and SOD activity increased concordantly with the pressure increase. Although a statistically significant change in TBARS levels started from 100% oxygen exposure at 1 ATA (normobaric), SOD activity was affected after 2 ATA. A significant correlation exists between exposure pressure and the aforementioned parameters. Ambient air exposure at 3 ATA did not affect any parameters besides the brain TBARS levels. CONCLUSIONS: It is clear that HBO exposure causes oxidative stress. The main reason for this effect seems to be exposure to pure oxygen, since pure high pressure has no significant effect on the aforementioned parameters. However, clinicians should use as low pressures as possible since all oxidative parameters appear to be directly proportional to the extent of HBO exposure.

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 roles of HRCT and clinical parameters in assessing activity of suspected smear negative pulmonary tuberculosis.

BACKGROUND: Smear-negative pulmonary tuberculosis (SNPTB) constitutes a major problem in countries with a moderate or high TB prevalence. The value of high-resolution computed tomography (HRCT), chest x-ray and other clinical findings in determining activity of SNPTB were investigated. METHODS: The study population consisted of 85 patients with suspected SNPTB, of whom 52 were confirmed as active pulmonary TB according to either culture positivity for Mycobacteriun tuberculosis or demonstration of caseous granulomatous inflammation. The remaining 33 patients accepted inactive TB sequel. RESULTS: Cough and expectoration were significantly frequent in inactive group whereas chest pain was detected higher in active patients. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of HRCT in detecting disease activity were 88, 88, 92, 83 and 88%, respectively. Centrilobular nodules, other non-calcified nodules, consolidation and cavity were significantly higher on HRCT in active group. Chest x-ray scores that were graded 1 to 3 showed a linear trend for the disease activity. CONCLUSIONS: HRCT has good diagnostic value in detecting activity of SNPTB, and some clinical findings may help in predicting the activity.

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.

Gross mural cartilage in a congenital bronchogenic cyst: MRI features.

An infant who had a cardiac murmur after the delivery was evaluated with echocardiogram. A 1 cm cystic area was incidentally identified in the upper right mediastinum, that was not related with the heart. A 4 x 4.5 x 8 cm cystic mass in the superior mediastinum and lower neck was demonstrated on the magnetic resonance imaging (MRI). At surgery, a small solid structure corresponding to the nodule seen on MRI was identified, which was firm and cartilaginous in nature and attached to the wall of the cyst. Grossly visible cartilage in association with a bronchogenic cyst has not been previously reported. In conclusion, the bronchogenic cysts can have grossly visible cartilage in their wall and extend to extrathoracic spaces in a contiguous fashion, mimicking other entities such as teratomas and cystic lymphangiomas.

[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.

[Tuberculin skin test screening in a military school in Istanbul city center]. / Istanbul il merkezindeki bir askeri okulda tüberkülin cilt testi taramasi

To investigate the reason of high incidence of annual patients with tuberculosis (TB) in a military school previously known by screening tuberculin skin test (TST) and finding out the proportion of annual infection risk (PAIR), the prevalance of TB infection and the distribution for each grades. Our study is a cross-sectional epidemiologic study made about TB infection. TST were screened for all students in the school. 5 TU PPD was injected to every student and after 72 hours, the results were evaluated by measuring the diameter of enduration. Test was repeated after 10 days for negative reactions. Age, sex, the number of BCG wound, smoking and dwelling for last 5 years were asked from the students and their answers were recorded. More than 10 mm enduration for cases who had no BCG and 15 mm enduration for cases who had BCG were accepted positive. Chest roentgenogram was taken for each student enrolled into the study. Infection prevalance and PAIR were calculated after tests and measurements. The total number of students was 948. Of 917 (96.7%) were male and 31 (3.3%) were female. The mean age was 19.72 +/- 1.25. The mean of TST was 12.79 +/- 5.96 mm for all students. According to the number of BCG scar, the numbers of students, percentage and the mean of TST were like that 70 (7.3%) cases no BCG scar 8.41 +/- 7.87 mm, 393 (41.4%) students one BCG scar, 11.94 +/- 6.26 mm, 343 (36.1%) cases two BCG scars, 13.74 +/- 5.12 mm, 142 (14.9%) students three or more then three scars, 14.97 +/- 4.11 mm. In the students who had no BCG, TST positivity was 50%. TB infection prevalance of entire school and PAIR were 46% and 3.44% (respectively). In this study, we found that increased number of BCG wound associated with the increased diameter of TST enduration. The proportion of unvaccinated students was similar to the same age population in our country but it showed differences in the distribution of regions. The students who started first grade had serious TB infection risk in their first school year. We think that PAIR values derived from TST conversions done in high risky community by screening annual TST could show all aspects of TB infection risk in those community.

A new utilization area for hyperbaric oxygen? Improving quality of stored blood.

BACKGROUND/AIM: Since blood bags have the ability for diffusion of gases, we investigated whether hyperbaric oxygen (HBO) exposure affects several vital parameters of stored blood. MATERIALS AND METHODS: Bloods obtained from the same persons were used as both control and HBO groups and stored in pediatric bags with citrate-phosphate-dextrose solution. HBO administration was performed at 2.5 atm for 90 min, started 1 day after blood collection and repeated every 2 days for a total of 10 times. The study was terminated on the 21st day. Complete blood count, glucose, pH, and osmotic fragility values were measured every week. RESULTS: Glucose and pH levels decreased in stored blood. In the HBO-exposed group, these decreases were less than in the control. In addition, mean corpuscular and platelet volumes tended to increase during storing process, but with HBO, these indexes remained lower, near physiologic levels. Another interesting finding of the study was the relative stable osmotic fragility ratio in the HBO group compared to the control blood. CONCLUSION: HBO exposure has positive effects on pH, stability of erythrocytes, and energy source (glucose) of the medium. Thus, we concluded that HBO may be a useful application for life and quality of stored blood.