Monitoring of inflammatory blood biomarkers in foals with Rhodococcus Equi pneumonia during antimicrobial treatment.

Rhodococcus equi (R. equi), a gram-positive facultative intracellular pathogen, is a common cause of pneumonia in foals and represents a major cause of disease and death. The aim of the present study was to investigate the time-depended changes in White Blood Cells (WBC), basophils (Baso), neutrophils (Neu), lymphocytes (Lymf), monocytes (Mon), eosinophils (Eos), platelet (PLT) counts, fibrinogen (Fbg) concentration, interferon (IFN-α, IFN-γ) and interleukins (IL-2 and IL-10) in foals with clinical R. equi pneumonia. The main treatment was with azithromycin-rifampicin for 14 days. Blood was sampled prior to, 7 and 14 days after starting therapy. Treatment was associated with significantly decreased counts of WBC, (25.6 ± 6.7 and 14.2 ± 2,7 × 103/ml), Neu (18.6 ±6.2 and 10.7 ± 3.1 × 103/ml), Mon (1.5 ± 0.5 and 0.9 ± 0.2 × 103/ml) and Fbg (539 ± 124 and 287 ± 26 g/dl) between day 0 and day 14. IL-2 and IL-10 concentrations were significantly increased (P = 0.028, P = 0.013, respectively) after treatment, whereas IFN-α and IFN-γ concentrations were not. The diagnostic potentials of INF-α, INF-γ, IL-2 and IL-10 per se seems not very high, however, the study suggests that the activity change of selected interleukins in the course of the disease may be associated with amelioration. We concluded that patterns of serum concentration changes of INF-α, INF-γ, IL-2 and IL-10 may help in the study of the innate immune response in foals during infection and treatment of R. equi pneumonia.

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.

Pulmonary artery embolism due to a ruptured hepatic hydatid cyst: clinical and radiologic imaging findings.

Hydatid pulmonary embolism is an uncommon condition resulting from the rupture of a hydatid heart cyst or the opening of a visceral hydatid cyst into the venous circulation. We report a rare case with multiple intra-arterial pulmonary hydatid cyst emboli originating from a hepatic hydatid cyst ruptured into the hepatic segment of the inferior vena cava. We present the ultrasonography findings of hepatic hydatid cyst and multidetector computed tomography pulmonary angiography images demonstrating both multiple hydatid cyst emboli and their hepatic origin.

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.

Primary nasolacrymal tuberculosis diagnosed after dacryocytorhinostomy.

Although tuberculosis (TB) is common and well recognized in many countries, unusual presentations of the disease sometimes raise difficulties in differential diagnosis. Primary tuberculosis of the lacrimal sac and the nasolacrimal duct is an extremely rare presentation of extra-pulmonary tuberculosis. Dacryocystorhinostomy alone is not sufficient for the treatment of these patients and an anti-tuberculous therapy has to be added. Here we present a patient with primary tuberculosis, which is limited to the inferior meatus and filled the entire lacrimal sac on the left side. The patient underwent endoscopic dacryocystorhinostomy due to obstruction of the nasolacrimal duct and culture of the granulation tissue, taken from the lacrimal sac revealed mycobacterial tuberculosis. The patient was improved with anti-tuberculous therapy that was added to the surgery. Primary tuberculosis is a rare granulomatous disease of the nasolacrimal system, which should be considered in the differential diagnosis to plan the effective treatment.

[Diagnosis of venous thromboembolism by single-detector row and multi-detector row CT angiography]. / Venöz tromboembolizm tanisinda tek detektör sirali ve çok detektör sirali BT anjiyografi.

Aim of this study is to determine the diagnostic value of pulmonary angiography performed by either single-detector row CT (SDCT) or multi-detector row CT (MDCT) in patients suspected of venous thromboembolism (VTE). SDCT was performed on 36 and MDCT on 18 of total of 54 patients on whom V/Q scintigraphy was obtained with a suspicion of VTE. Sixteen out of 54 cases got additional pulmonary DSA. Statistical analyses were based on final clinical diagnoses of the individual cases. Twenty-six out of 54 cases in the study got the final diagnoses of VTE and VTE was certainly excluded in the remaining 28. Sixteen out of true 26 VTE cases were in the SDCT group while the other 10 cases took place in the MDCT group, none of which was missed by either technique. There was one false positive result in the SDCT group and none in the MDCT group (96% and 100% specificity respectively, 100% sensitivity for both). Only 9% of all pulmonary emboli detected by SDCT assisted pulmonary angiography were located in subsegmental arterial branches, whereas 24% of emboli detected by MDCT angiography were subsegmental. Both SDCT and MDCT angiography are reliable tests in the detection of VTE. MDCT assisted pulmonary angiography is superior than SDCT assisted pulmonary angiography in subsegmental VTE detection.

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.

Reduced pulmonary function in wind instrument players.

BACKGROUND: Wind instrument playing requires a strenuous respiratory activity. Previous studies investigating effect of wind instrument playing on pulmonary function are equivocal. METHODS: In the present study, 34 male, non-smoker wind players in a military band were compared with 44 healthy non-smoker males by pulmonary function testing. RESULTS: All spirometric values including forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow rate, forced expiratory flow in 25, 50, 75% of FVC, and during the middle half of the FVC were found significantly diminished in wind players. The class of wind instrument, brass or wood, showed no significant differences. FVC was significantly and negatively correlated with duration of practice. CONCLUSIONS: It was concluded that pulmonary function in wind players might be diminished probably due to development of asthma or constant barotrauma during their playing. This fact should be considered in clinical evaluation of wind instrument players.

Effect of respiratory muscle endurance training in patients with COPD undergoing pulmonary rehabilitation.

BACKGROUND: Respiratory muscle endurance training (hyperpnea training) has been shown to have beneficial effects in patients with COPD. STUDY OBJECTIVES: The purpose of this study was to determine whether hyperpnea training, when added to an endurance exercise training program, would lead to additional benefits compared with endurance training alone in patients with COPD. SETTING AND PARTICIPANTS: Patients with COPD entering an 8-week outpatient pulmonary rehabilitation program. Fifteen patients (mean [+/- SE] FEV1, 45 +/- 6% predicted) were randomized to combined therapy, and 14 patients (mean FEV1, 44 +/- 4% predicted) were randomized to endurance training. METHODS: Peak exercise capacity, exercise endurance time during constant workload cycle exercise, 6-min walk distance, quality of life as measured by the chronic respiratory questionnaire, respiratory muscle strength and endurance, and quadriceps fatigability were measured before and after endurance or combined training. RESULTS: After rehabilitation, peak exercise capacity, exercise endurance time, 6-min walk distance, and quality of life all increased in both groups, but there was no significant difference in the extent of improvement between groups. Mean respiratory muscle endurance increased to a significantly greater extent in the combined therapy group (17.5 +/- 2.7 vs 8.5 +/- 2.5 min, respectively; p = 0.02). Respiratory muscle strength was significantly increased, and quadriceps fatigability was significantly reduced after rehabilitation in the combined therapy group but not in the endurance training group, but the difference between groups did not reach statistical significance. CONCLUSION: The endurance of the respiratory muscles can be improved by specific training beyond that achieved by endurance training alone in patients with COPD. However, this improvement did not translate into additional improvement in quality of life or exercise performance.

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.

[Detection of primary drug resistance rates of Mycobacterium tuberculosis complex strains isolated between 2002-2003 years and comparison with the data of 1998-2001 period]. / 2002-2003 yillari arasinda izole edilen Mycobacterium tuberculosis kompleks suslarinda primer ilaç direnç oranlarinin saptanmasi ve 1998-2001 verileriyle karsilastirilmasi.

In this retrospective study, it was aimed to evaluate the primary drug resistance rates of 151 Mycobacterium tuberculosis complex (MTC) strains against primary anti-tuberculosis (anti-TB) drugs, isolated from 2213 tuberculosis suspected patients between January 2002 to December 2003 in our hospital, and also to compare these results with the data obtained from our previous results between January 1998 to December 2001. It has been detected that there was a significant decrease in the susceptibility rates of MTC isolates to all anti-TB drugs both yearly from 1998 to 2003 (p < 0.001), and for the total of 1998 and 2003 years period (p < 0.029). When only the years 1998 and 2003 were taken into consideration, significant increases were found in any (one or more) combination of the drugs with isoniazid (INH), and only INH resistance rates (p < 0.007 and p < 0.033, respectively). Thus, naturally there was also an increase in resistance to total any drug resistance (p < 0.029). We suggest that strict measures such as "directly observed therapy" should be undertaken in order to prevent development of drug resistance particularly against INH. Regular and continuous screening of anti-TB drug resistance should be accomplished to survey the presence of drug resistant strains in the nation, to define the suitable drug regimens and to evaluate the quality of tuberculosis control programs.

[Pulmonary alveolar microlithiasis]. / Pulmoner alveoler mikrolitiyazis.

Pulmonary alveolar microlithiasis (PAM) is a rare, chronic lung disease characterized by extensive intra alveolar calcium and phosphate deposition throughout both lung parenchyma. Etiology and pathogenesis of PAM is not known. There are some hypothesis for etiology and pathogenesis of PAM but none of them are satisfactory. The incidence of PAM is high in countries such as Turkey, Italy and USA. There is a surprising discordancy between radiological appearance and clinical presentation. Chest X-ray appearance of PAM is almost pathognomonic. Patients with PAM may have all findings of interstitial lung disease in varying degrees as well as micro-nodules on their HRCTs. Patients with PAM usually asymptomatic until the underlying process affects alveolar gas exchange however patients may ultimately develop hypoxemia and cor pulmonale. A definitive therapy for PAM did not exist. Patients with advanced lung disease may benefit from lung transplantation.

[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.