Nefes darlýðý ve öksürük þikâyetleri olan 43 yaþýndaki erkek hasta, 20 yýldýr kaynakçýlýk yapmakta ve 30 yýldýr güvercin beslemekteydi. Radyolojide yaygýn mikronodüler opasiteler, güvercin besleme öyküsü ve hipoksemi olmasý nedeniyle ile ön taný olarak hipersensitivite pnömonisi düþünüldü. Ancak güvercinlerin uzaklaþtýrýlmasýna raðmen þikâyetlerinin devam etmesi, bronþ lavajýnda lenfositik/nötrofilik alveolitis bulgusunun olmamasý, akciðerde fibrozis olmamasýna raðmen kortikosteroide yanýtsýzlýk ve normal akciðer difüzyon kapasitesiyle bu tanýdan uzaklaþýldý. Kaynakçý akciðeri hastalýðý, meslek ortamýndaki demir tozlarýnýn varlýðý, uyumlu radyoloji bulgularý, serum ferritin yüksekliði ve bronþ lavajýnda Prusya mavisi ile boyanmýþ demir granüllerinin görülmesiyle kondu. Hastanýn hipoksemisinin yapýlan bronþ lavajý sonrasý demir granüllerinin uzaklaþtýrýlmasýyla düzeldiði dü-þünüldü. Hastaya tedavi olarak mesleðini deðiþtirmesi, sigarayý býrakmasý ve güvercinlerden uzaklaþmasý önerildi. Çünkü bu faktörler ileride akciðer fibrozisi, astým ve akciðer kanseri geliþimine sebep olabilmektedir.

A 43-year-old man with a dyspnea, and cough had been a welder for 20 years, and had raised pigeons for 30 years. A pre-diagnosis of hypersensitivity pneumonitis was proposed with multiple micronodular opacities in radiology, exposure to pigeons, and hypoxemia. However, it was ruled out with continuing lung symptoms though avoidance of pigeons, no alveolitis in the bronchial lavage, corticosteroid insensitivity, and normal diffusion lung capacity. A diagnosis of welder’s lung disease was made with the occupational environment consisting of iron dust particles, compatible chest radiology, and positive staining for ferritin (Prussian blue stain) of the macrophages in the bronchial lavage. His hypoxemia was thought to improve after bronchial washing. He was recommended to quit his job and quit smoking, as well as feeding pigeons, since these factors potentially had an effect and predispose lung fibrosis, asthma, and cancer.

Diþ teknisyeni pnömokonyozu yeni tanýmlanan, nadir, farklý bir pnömokonyoz grubudur. Diþ teknisyenleri tarafýndan kullanýlan dental alloy, akrilik resin, kuvartz, karbon, silika ve aðýr metal tozlarýna doðrudan maruziyet ve soluduklarý havada fazla miktarda bulunmasýnýn sonucunda geliþir. Solunum yakýnmalarýyla baþvuran ve diþ teknisyeni pnömokonyozu tanýsý konulan üç olguyu sunuyoruz.

Dental technician’s pneumoconiosis is a newly described, rare, and distinct type of pneumoconiosis. It is a result of direct exposure to dental alloy, acrylic resin, quartz, carbon, silica, and hard metal dust that are abundant in the air respired by dental technicians. We report herein three patients with respiratory complaints who were diagnosed with dental technician’s pneumoconiosis.

Ýlaca baðlý akciðer hastalýðýnýn ayýrýcý tanýsý zordur. Klinik, histolojik bulgularýn özgül olmamasý ve altta yatan hastalýðýn varlýðý ilaca baðlý akciðer hastalýðýnýn tanýsýnda zorluk yaratýr. Romatoid artrit tanýsý alan ve üç aydýr sulfasalazin kullanan 33 yaþýnda erkek hasta öksürük, nefes darlýðý ve kilo kaybý þikâyeti ile baþvurdu. Fizik muayenesinde romatoid artritin eklem tutulumu dýþýnda patolojiye rastlanmayan hastanýn toraks BT’sinde bilateral üst loblarda non homojen konsolidasyon alanlarý saptandý. Olguda mevcut klinik ve radyolojik bulgular sonucunda sulfasalazine baðlý akciðer hastalýðý düþünüldü. Sulfasalazin tedavisi kesildi ve klinik ve radyolojik düzelme görüldü. Sulfasalazine baðlý akciðer hastalýðý nadir görülmesi nedeni ile literatür bilgileri eþliðinde sunmayý amaçladýk.

The differential diagnosis of drug-induced lung disease is difficult. Due to non-specific clinical and histological findings and the presence of underlying disease, the diagnosis of drug induced pulmonary disease is difficult. A 33-year-old man with a diagnosis of rheumatoid arthritis who had been treated with sulfasalazine for three months was admitted due to coughing, dyspnea, and weight loss. There were no pathological findings in the physical examination. Non-homogeneous infiltrates in the bilateral upper lobes were seen on the thorax CT. With these clinical and radiological findings in the patient, sulfasalazine-induced lung disease was considered. After sulfasalazine treatment was terminated, the patient's clinical and radiological findings improved. Because sul-fasalazine-induced lung disease is rarely observed, we aimed to present this case with literature reviews.

Sýk deðiþken immün yetmezlik (SDÝY) immünglobulin üretiminde defekt ile karakterize, klinik önemi olan en sýk primer immün yetmezliktir. Tekrarlayan bakteriyel enfeksiyonlar, otoimmün hastalýklar ve malignite insidansýnda artýþ ile seyreder. Akciðerde bronþektazi, interstisyel tutulum, nodüler oluþumlar, granülomatöz hastalýk ve interstisyel pnömoniye neden olabilir. Öyküsünde pernisiyöz anemi, hashimato tiroiditi, 6 yýl önce taný konulmuþ mide karsinomu bulunan 31 yaþýnda erkek olgu kliniðimize baþvurdu. Olguya gastrektomi uygulanmýþ, kür olmuþ ve onkolojik takibinde ilk yýlda akciðerde nodüller saptanarak kemoterapi uygulanmýþtý. Kemoterapi sonrasýnda akciðer görüntülemelerinde yeni nodüller geliþmiþ ve metastaz olduðu düþünülerek takibe devam edilmiþti. Takiplerde nodüllere taný amaçlý ileri merkeze yönlendirilmiþti. Kliniðimizde çekilen tomografide nodüllerin yer deðiþtirdiði ve bronþektazilerin eþlik ettiði görüldü ve immünoglobulinlerinde düþüklük saptandý. SDÝY tanýsý konularak immünoloji bölümüne yönlendirildi. Nadir görülen, tanýsý oldukça gecikmiþ olan olgu, literatürler eþliðinde sunuldu.

Common variable immunodeficiency (CVID) is the most common clinically important primary immuno-deficiency that is characterized by frequent bacterial infections, autoimmune diseases, and increased incidence of malignancy. CVID can cause bronchiectasis, interstitial involvement, nodular formations, granulomatous disease, and interstitial pneumonia. A 31-year-old male patient who had a history of pernicious anemia, Hashimoto's thyroiditis, and gastric carcinoma diagnosed six years ago, was admitted to our clinic. He had undergone gastrectomy and was cured. In the first year of follow-up in the oncology clinic, lung nodules were detected and chemotherapy was administered. After chemotherapy, new nodules were accepted as metastasis and he was referred to a tertiary center for diagnosis. We hospitalized the case for further investigation. The tomographic imaging showed remarkable bronchiectasis accompanied by multiple nodules that were migrating compared to the previous images. Serum immunoglobulin levels decreased and he was diagnosed with CVID. The case, rarely seen and diagnosed quite late, is presented in the light of the literature.

Sarkoidoz etyolojisi bilinmeyen, dokularda nonkazeifiye granülomatöz reaksiyon ile karakterize multisistemik bir hastalýktýr. Löfgren sendromu ise ateþ, artrit ve/veya artralji, eritema nodozum ve bilateral hiler lenfadenopati ile karakterize akut sarkoidoz tablosudur. Klinik olarak akciðer bulgularý tabloya hakim olsa da giderek artan sýklýkta romatolojik bulgularýn ön planda olduðu sarkoidoz olgularý bildirilmektedir. Bu yazýda bilateral ayak bileklerinde artrit ile baþlayan Löfgren Sendromu tanýsý konan bir bayan olgu sunulmuþtur.

Sarcoidosis is a multisystem disease that is characterized by non-caseating granulomatous reaction with unknown etiology. Lofgren's syndrome is an acute form of sarcoidosis, characterized by fever, arthralgia and/or arthritis, erythema nodosum, and bilateral hilar lymphadenopathy. Although lung symptoms are clinically dominant, there are an increasing number of cases with dominant rheumatologic symptoms. Herein, we reported a female patient who was diagnosed as Lofgren's syndrome presenting with bilateral ankle arthritis.

Pulmoner alveoler mikrolitiyazis (PAM), küresel kalsiyum fosfat taþlarýnýn (mikrolit) intra-alveoler birikimi ile karakterize nadir görülen diffüz bir akciðer hastalýðýdýr. Hastalýk bir kaç ülkede, özellikle de Türkiye, Ýtalya ve Japonya'da sýk görülmektedir. Hastalarýn çoðunun taný konduðu anda hiçbir þikâyeti olmadýðýndan, hastalýk genellikle bizim olgumuzda olduðu gibi diðer nedenlerle çekilen akciðer grafisi sýrasýnda tesadüfen teþhis edilir. SLC34A2 gen mutasyonlarý PAM neden olabilir. PAM’in karakteristik radyolojik bulgularý genellikle orta ve alt zonlarda saptanan bilateral ince kum benzeri mikronodüllerdir. Her ne kadar birçok yazar, tipik radyolojik paternin çoðu durumda akciðer biyopsisi ihtiyacýný ortadan kaldýrdýðýný iddia etse de, akciðer biyopsisi PAM tanýsýnýn doðrulanmasý için en kesin tanýsal prosedürdür. Hastalýk için herhangi bir bilinen etkin bir tedavi yoktur. Biz, patolojik olarak taný konan PAM olgusunu, literatür eþliðinde sunuyoruz.

Pulmonary alveolar microlithiasis (PAM) is a rare diffuse lung disease characterized by intra-alveolar accumulation of spherical calcium phosphate concretions (microliths). The disease predominates in a few countries, particularly Turkey, Italy, and Japan. Since most of the patients have no symptoms at the time of diagnosis, the disease is usually diagnosed incidentally during pulmonary radiography for other reasons, as in the current case. The SLC34A2 gene mutations can cause PAM. Characteristic radiographic findings of PAM consist of bilateral, fine, sand-like micronodules typically in the middle and lower zones. Although many authors argue that the typical radiological pattern precludes the requirement for a lung biopsy in most cases, it remains the most definitive procedure for confirmation of PAM. There is no known effective treatment for the disease. We present a case of pathologically diagnosed PAM with a review of the literature.

Malign mezotelyoma asbest temasýndan 20-40 yýl sonra ortaya çýkan, prognozu kötü bir tümördür. Burada 27 yaþýnda, bilinen asbest temasý olmayan bir malign plevral mezotelyoma olgusu sunulmuþtur. Sigara öyküsü olmayan bayan hasta nefes darlýðý ve yan aðrýsý ile baþvurdu. Fizik muayenede, sað alt zonda matite tespit edilen hastanýn akciðer grafisinde saðda orta zona kadar uzanan serbest plevral efüzyon ve her iki akciðerde multipl, nodüler dansiteler saptandý. Plevral sývý incelemesinde hemorajik karakterde eksüdatif efüzyon izlendi. Plevral sývýn ADA seviyesi, ARB ve mikobakteri kültürü negatif bulundu. Sývý sitolojisi malignite açýsýndan kuþkulu bulunan hastada primer odak araþtýrmasý yapýldý. Hastaya torakoskopi planlandý, pariyetal plevrada lokal tümör odaklarý, visseral plevrada kalýnlaþma gözlendi. Biyopsi örneklerinin patoloji ve immün boyama sonuçlarý bifazik malign mezotelyoma olarak raporlandý. Sonuç olarak, malign plevral efüzyon varlýðýnda mezotelyoma olasýlýðý göz ardý edilmemeli ve tanýyý kesinleþtirmek için ayrýntýlý immünohistokimyasal inceleme yapýlmalýdýr.

Malignant mesothelioma is a tumor with poor prog-nosis that usually occurs 20-40 years after asbestos exposure. Here, we present a 27-year-old patient with malignant pleural mesothelioma who did not report any asbestos exposure. A female non-smoker was admitted with complaints of chest pain and dyspnea. The physical examination revealed dullness with percussion in the right lower lobe. There was a free-flowing pleural effusion through the right middle zone and bilaterally nodular opacities in chest x-ray. The ADA level, ARB and mycobacterium culture of the pleural fluid were negative. There were some malignant cells in the cytological examination of the fluid, and therefore the primary site of malignancy was evaluated. Thoracoscopy revealed nodular tumoral infiltration in the parietal pleura and thickness of the visceral layer. The pathological examination and immunostaining of the biopsy specimens were reported as biphasic malignant mesothelioma. In conclusion, mesothelioma should be considered in the case of malignant pleural effusion and detailed immunostaining should be performed in order to ascertain the diagnosis.

Akciðerler, ekstratorasik malignitelerin sýk metastaz yaptýðý organlardýr. Metastazlar sýklýkla parankimal nodüller veya plevra tutulumu þeklinde olup endobronþiyal metastazlar nadirdir. Bu makalede görece olarak daha nadir görülen endobronþiyal metastaz yapan osteosarkom olgusundan bahsedilecektir. Otuz dört yaþýndaki erkek olgu, 10 ay önce sað humerustaki kitleden yapýlan biyopsiyle osteosarkom tanýsý almýþtý. Neoadjuvan kemoterapi sonrasýnda opere edilen ve adjuvan kemoterapi alan hastanýn kol bölgesindeki tümörü kontrol altýndaydý. Baþvurusundan iki hafta önce baþka bir merkeze 6 haftadýr artan nefes darlýðý ve hemoptizi yakýnmalarýyla baþvurmuþ, sol akciðerinde total atelektazi saptanmýþtý. Sol ana bronþ distalinde lümeni tam týkayan endobronþiyal lezyon rijid bronkoskop ile çýkarýlmýþ, patolojik incelemesi osteosarkom metastazý olarak deðerlendirilmiþti. Devam eden hemoptizi yakýnmasýyla kliniðimize baþvuran hastanýn toraks bilgisayarlý tomografisinde büyüðü sol alt lob superior segmentte olan, çok sayýda metastatik kitle ve nodüller saptandý. Fiberoptik bronkoskopik incelemede sol alt lob bronþu giriþini tama yakýn týkayan tümöral lezyon izlendi. Endobronþiyal tedaviye uygun bulunmayan hastaya palyatif amaçlý eksternal radyoterapi planlandý.

Pulmonary metastases from extrathoracic malignan-cies are common and frequently seen as parenchy-mal nodules and pleural involvement. Endobronchial metastases are rare. We present a 34-year-old male who was diagnosed with right humerus osteosarcoma 10 months ago. Although the primary tumor had been controlled with surgical resection following preoperative chemotherapy and postoperative adjuvant chemotherapy, he had hemoptysis. He was admitted to another center two weeks ago with progressive dyspnea and episodes of hemoptysis within six weeks. Rigid bronchoscopy was performed for left lung atelectasis and tumor obstructing distal part of left main bronchus was removed. The pathological evaluation revealed osteosarcoma metastasis. In our clinic, we performed a thorax computerized tomography showing multiple metastases, the largest located in the apical segment of the lower left lobe. A tumoral lesion nearly obstructing the lower left lobe bronchus was seen during fiberoptic bronchoscopy. The tumor was inappropriate for endobronchial treatment and palliative external radiotherapy was planned.

Wegener granülomatozu (WG), üst ve alt solunum yollarýnýn nekrotizan granülomatöz vaskülitine iliþkin klinik- patolojik belirtileri, glomerülonefrit ve küçük damar vasküliti ile karakterize multisistemik tutulum yapan bir hastalýktýr. Ateþ, eritrosit sedimantasyon hýz yüksekliði, halsizlik bulgularý ile baþvurup, progresif böbrek yetmezliði saptanan, geniþ spektrumlu antibiyotik tedavisine raðmen pulmoner lezyonlarda progresyon gözlenen 68 yaþýnda bayan hasta, böbrek biyopsisi sonrasýnda WG tanýsý almýþtýr. Ýkinci olgumuz ise; ilk semptomu iþitme kaybý olan 31 yaþýnda erkek hasta 2 aydýr tekrarlayan üst solunum yolu enfeksiyon ataklarý ve son 1 haftadýr devam eden ateþ, halsizlik yakýnmasý ile baþvurdu. c-ANCA pozitifliði saptanan her iki olguyu enfeksiyon kliniði ile baþvurmuþ olup daha sonra Wegener tanýsý almasý nedeniyle sunmayý uygun bulduk.

Wegener’s granulomatosis (WG) is a necrotizing granulomatous vasculitic disease that particularly involves the upper and lower respiratory tract and kidneys. A 68-year-old female patient was admitted to the hospital, a high erythrocyte sedimentation rate, fever, and progressive renal failure. Progression was observed in the patient's pulmonary infiltrations in spýte of wide- spectrum antibiotherapy. The renal biopsy revealed Wegener’s granulomatosis. The second case, whose the first symptom was hearing loss, was a 31-year-old male patient who was admitted to the hospital with recurrent episodes of upper respiratory tract infection for two months and with symptoms of fever, and malaise for one week. The WG case with multiple organ involvement in which c-ANCA was determined positive and responded to treatment is discussed in this case presentation

Antineutrophil cytoplasmic antibody (ANCA) iliþkili vaskülit sendromlarý klinik olarak heterojen olan otoimmün, nekrotizan ve küçük damarlarý tutan vaskülitlerdir. Etyolojisi tam olarak bilinmemesine raðmen genetik ve çevresel faktörler suçlanmaktadýr. Ayrýca kronik havayolu hastalýklarý ile vaskülitler sýklýkla birlikte rapor edilmiþlerdir. Burada çocukluðundan beri astým ve bronþektazileri olan ve yýllar sonra bu havayolu hastalýklarýna sekonder olarak mikroskopik polianjitis geliþtiði düþünülen bir olguyu sunmayý amaçladýk.

Anti-neutrophil cytoplasmic antibody (ANCA)-related vasculitis syndromes are a heterogeneous group of auto-immune vasculitic disorders that cause necrotizing inflammation in small vessels. Although the underlying causes are not clear, genetic and environmental factors are thought to play a major role. Meanwhile, chronic airway diseases are frequently reported to accompany vasculitic syndromes. Here we present a case with preexisting childhood asthma and bronchiectasis that developed microscopic poly-angiitis years after the onset of airway diseases that were assumed to be secondary to his preexisting airway conditions.

Yað embolisi, genellikle uzun kemik travmasýnýn komplikasyonu olarak ortaya çýkan nadir bir durum-dur. Travma sonrasý 24-72 saat sonra solunum sistemi, santral sinir sistemi, üriner sistem, göz ve deride semptom ve bulgular ile kendini gösterir. Araç dýþý trafik kazasý nedeni ile femur kýrýðý olan 19 ve 23 yaþýnda 2 erkek hasta, nefes darlýðý, bilinç bulanýklýðý, ateþ, göðüs ön bölgesinde ve ön aksiler bölgede peteþiyal döküntü nedeni ile deðerlendirildi. Hastalarýn akciðer grafisi ve kranial tomografileri normaldi. Kan gazýnda hipoksi hipokapni mevcuttu. Bilinç durumunu açýklayacak patoloji saptanmadý. Klinik kriterlere göre taný koyduðumuz iki olguya da, streoid, profilaktik heparin, oksijen ve sývý tedavisi verildi. Tedavi sonrasý oksijenizasyonu ve bilinç durumu düzelen hastalara ortopedi tarafýndan operasyon uygulandý.

Fat embolism syndrome is a rare condition that usually occurs as a complication of long bone trauma. It becomes apparent 24-72 hours after injury, with respiratory, neurological, urinary, ocular, and cutaneous symptoms and signs. Two male patients, 19 and 23 years old, with femur fractures, due to a traffic accident were evaluated for dyspnea, confusion, fever, petechial skin rash on the anterior thorax, and anterior axillary folds. Chest x-rays and cranial CT scans of the patients were normal; there was hypoxemia and hypocapnia in the measurement of the arterial blood gases. There were no pathologic findings to explain consciousness. The two patients, who had clinical diagnostic criteria, were given steroid prophylactic heparin, oxygen, and fluid therapy. Oxygenation and state of consciousness improved after treatment and the cases were operated on by orthopedics.

Desmoid tümör olarak da bilinen fibromatozis oldukça nadir görülen yumuþak doku tümörüdür. Histolojik olarak iyi huylu yumuþak doku tümörleri içerisinde sýnýflandýrýlsa da, bazý kaynaklar düþük grade fibrosarkoma olarak kabul etmektedir. Metastaz yapmadýklarý bilinir ancak komþu organlara yayýlýrlar. Bu yüzden total çýkarýlmalarý önerilir. Etyolojisi, travma, cerrahi, hormonal bozukluk olarak bilinen ve kadýnlarda daha fazla görülen bir hastalýktýr. Travma öyküsü olan, sað tarafta dolgunluk hissi ve nefes darlýðý þikâyeti ile baþvuran 18 yaþýnda kadýn hastada önce mini torakotomi ile taný konuldu. Sonuç desmoid tümör gelince kitleyi total olarak çýkardýk.

Fibromatosis is also known as desmoid tumor and a rarely seen soft tissue tumor. Some reports categorize them as low grade fibrosarcoma, although they are histologically classified among benign soft tissue tumors. They are known to not metastasize but invade into the neighboring tissues. Therefore, their removal is essential. The etiology includes trauma, surgery, and hormonal disturbance, they are common in women. The diagnosis was made via mini thoracotomy in an 18-year-old woman with shortness of breath, dullness in the right chest, and trauma in her past. We completely removed the mass when the result yielded desmoid tumor.

Fibröz histiositom, deðiþen oranda inflamatuar hücrelerin, köpüksü histiositlerin ve siderofajlarýn eþlik ettiði, fibroblastik ve histiositik hücrelerden oluþan, histomorfolojik olarak tabakalar ya da kýsa demetler halinde görülen benign tümöral bir lezyondur. Genellikle bu tümörler, dermis ya da yüzeyel subkutan doku yerleþimlidir. Akciðer yerleþimli fibröz histiositom oldukça nadir bir tümördür. Arka-ön akciðer grafisinde nodüler opasite þeklinde ortaya çýkan, bilgisayarlý tomografi ve PET-CT taramalarýnýýn ardýndan öncelikli olarak malign kabul edilip opere edilen ve patoloji sonucu primer akciðer benign fibröz histiositomu olarak bildirilen bir olguyu sunduk.

Fibrous histiocytoma is a benign tumoral lesion consisting of fibroblastic and histiocytic cells, accompanied by varying numbers of inflammatory cells, foamy histiocytes and siderophages, and has sheet- or short fascicle-type histomorphology. These tumors are generally localized in the dermis or the superficial subcutaneous tissue. Fibrous histiocytoma of the lung is an extremely rare tumor. This study presents a case that appeared as a nodular opacity in the posteroanterior (PA) lung graphy, which was then considered malignant after computerized tomography and PET-CT scans and operated on. The case was finally reported as primary benign fibrous histiocytoma of the lung after pathological examination.

Hidatik hastalýðý Türkiye'de endemiktir. Pulmoner hidatik hastalýðý tanýsý klinik ve radyolojik bulgularla konulabilmesine raðmen, atipik radyolojik görünüm tanýda gecikmelere ve yanlýþ taný konulmasýna neden olabilir. Yirmi iki yaþýnda bayan hasta hemoptizi ile baþvurdu. Bilgisayarlý toraks tomografisinde sað üst lobun anterior segmentinde atelektazi ve merkezinde nekroz içeren kitle lezyon saptandý. Bronkoskopi ile sað üst lobun anterior segmentinde beyazýmsý-sarý renkte jelatinöz membran görüldü. Bronþiyal yýkama ve forseps biyopsi ile hidatik hastalýðýnýn tanýsý konuldu.

Hydatid disease is endemic in Turkey. Although pulmonary hydatid disease may be diagnosed by clinical and radiological findings, atypical radiological presentation may lead to misdiagnosis or delays in diagnosis. A 22-year-old female was admitted with hemoptysis. Computed tomography of the thorax showed a mass lesion with central necrosis and atelectasis in the anterior segment of the right upper lobe. Bronchoscopy revealed a whitish-yellow gelatinous membrane in the anterior segment of the right upper lobe. Bronchial washing and forceps biopsy obtained diagnosis of hydatid diseases with cuticles.

Poland sendromu, pektoral kas yokluðu, farklý göðüs deformiteleri ve el anomalileri ile karakterize konjenital bir anomalidir. Zaman içinde sendrom için birçok yeni özellik tanýmlanmýþtýr. Pektoral kaslar dýþýnda birçok kasýn etkilendiði bildirilmesine karþýn biceps braki kasýnýn etkilendiði bildirilmemiþtir. Poland sendromunun en çok kabul edilen patogenezi gestasyonel dönemde subklavyen arterde veya dallarýnda geçici kan akýmýnýn kesilmesidir. Biceps braki kasýnýn arteri de subklavian arterin bir dalýdýr. Sað taraflý Poland sendromlu ve ipsilateral biseps braki kasýnýn kýsa baþýnýn hipoplazisi bulunan hastamýzý sunmaktayýz. Biseps braki kasýnýn anomalilerinin Poland sendro-munun bir komponenti olabileceðini düþünmekteyiz.

Poland's syndrome is a rare congenital anomaly characterized by absence of the pectoral muscles, different chest deformities, and hand anomalies. Over time, many new features of the syndrome have been described. Although it has been reported that many muscles, in addition to the pectoral muscles, might have been affected in patients with Poland’s syndrome, the biceps brachii muscle has never been reported to be affected. The most accepted pathogenesis of Poland's syndrome is a temporary interruption of blood flow of the subclavian artery or its branches in the gestational period. The artery of the biceps brachii muscle is a branch of the subclavian artery. Herein, we present a patient with right-sided Poland’s syndrome and ipsilateral hypoplasia of the short head of the right biceps brachii muscle. We believe that the abnormalities of the biceps brachii muscle might be a component of Poland's syndrome.

Yaygýn ilaç dirençli tüberküloz artýþ gösteren bir global saðlýk problemidir ve doðurganlýk çaðýndaki kadýnlarý da içeren genç eriþkinleri etkilemektedir. Gebelik döneminde geliþen yaygýn ilaç dirençli tüberküloz olgularýnýn tedavisi hala tartýþmalý olup geçmiþte gebe hastalara terapötik abortus uygulamasý önerilmiþtir. Bu yazýda gebelik sonlandýrýlmadan baþarý ile tedavi edilen yaygýn ilaç dirençli bir tüberküloz olgusu sunulmuþtur. Hasta saðlýklý bir bebek doðurmuþ olup, tedavinin bitiminden 8 ay sonra relapsý iþaret eden herhangi bir bulgusu da yoktur. Sonuç olarak, yaygýn ilaç dirençli tüberküloz gebelikle birlikte baþarý ile tedavi edilebilir bir hastalýktýr ve bu durumdaki kadýnlarýn gebeliklerini devam ettirme þansý kendilerine tanýnmalýdýr.

The widespread emergence of extensively drug-resistant tuberculosis is an increasing global health care problem and affects young adults, including women of childbearing age. The treatment of extensively drug-resistant tuberculosis during pregnancy is still controversial and therapeutic abortions were previously recommended for pregnant patients. We describe herein a severe case of extensively drug-resistant tuberculosis that was successfully treated during pregnancy. The patient delivered a healthy baby and had no signs of relapse eight months after completing the treatment. In conclusion, extensively drug-resistant tuberculosis can be treated successfully during gestation and pregnant women should have the option to continue their pregnancy.

Tüberküloz kontrol programlarýnýn birincil amacý toplum içinde hastalýðýn yayýlmasýný ve aktif tüberküloz hastalarýný olabildiðince erken saptayarak ve tedavi ederek tüberküloz insidansýný azaltmaktýr. Tüberküloz taný ve tedavisindeki gecikmeler toplumda enfeksiyonun bulaþma süresinin uzamasýna neden olur. Gecikmeler hasta gecikmesi, saðlýk sistemi gecikmesi ve toplam gecikme olarak gruplandýrýlýr. Bu yazýda akciðer tüberkülozunda gecikmelerin boyutu ve olasý nedenleri tartýþýlmýþtýr.

The primary goal of tuberculosis control programs is to minimize transmission within the community and reduce the incidence of tuberculosis by detecting and treating active tuberculosis cases as early as possible. Delays in the diagnosis and treatment of pulmonary tuberculosis can lead to a prolonged period of infection in the community. Delays are divided into patient delay, health care system delay, and total delay. The length of delays and possible reasons for delays in pulmonary tuberculosis patients are discussed in this paper.