A tuberculosis case ımitating ınterstitial lung disease

Yirmi iki yaşında, kadın hasta. 20 gün önce başlayan ve eforla oluşan nefes darlığı ve kuru öksürük dışında yakınması yoktu. Solunum sistemi bakısında bazallerde tek tük ince raller duyuluyordu. Rutin laboratuvar tetkikleri normal olan hastanın solunum fonksiyon testinde restriktif tipte bozukluk saptandı. Tüberkülin testi pozitif (18 mm) idi. Balgam çıkaramadığı için asidorezistan basil (ARB) bakılamadı. Akciğer grafisinde sağ akciğerde daha belirgin olmak üzere her iki akciğerde yaygın daha çok periferik yerleşimli retiküler dansite artışı, sağ diyafragmanın yüksek ve düzensiz konturlu olduğu izlendi. Yüksek rezolüsyonlu bilgisayarlı tomografide sağ üst lob apikal, posterior, orta lob, alt lob apikal segmentlerde; sol üst lob apikoposterior, alt lob apikal segmentlerde daha çok periferik yerleşimli retiküler dansiteler, yer yer peribronşiyal kalınlaşmalar ve sağ orta lobdakilere bir miktar buzlu cam görünümünün eşlik ettiği dansite artışları saptandı. Bronkoalveolar lavaj (BAL) ve bronş aspirasyon sıvısındaARBmenfi idi.BALincelemesinde alveoler makrofaj %56, lenfosit %30, PNL%12, eozinofil %2 olarak saptandı. Transbronşiyal akciğer biyopsisinde diyagnostik bir bulgu izlenmedi. Yapılan incelemelerle kesin tanıya gidilemediğinden hastaya açık akciğer biyopsisi yapıldı. Histopatolojik incelemede mikroskopik olarak akciğer parankiminde düzensiz dağılım gösteren kazeifiye granülom yapı ları gözlendi ve akciğer tüberkülozu ile uyumlu olarak değerlendirildi.Yapılan Ziehl-Neelsen asidorezistan basil boyasında granülomlarda birkaç basil saptandı. Olgu, interstisyel akciğer hastalığını taklit eden atipik radyolojik bulguları nedeniyle sunuldu.Twenty-two year old, female patient. Her complaints were dyspnea with exercise and a dry cough of 20 days. A few crepitations were heard during oscultation. Routine laboratory examinations were normal. Restrictive pattern was observed in pulmonary function tests. Tuberculin test was positive (18 mm). She could not give sputum sample for acid-fast bacillus (ARB) examination. Bilateral diffuse peripheral reticular infiltrates dominating in right lung were observed in chest x-ray and right hemidiyaphragma was high with irregular contours. There were peripheral reticular densities in right upper lobe apical, posterior, middle lobe, lower lobe apical; left upper lobe apicoposterior, lower lobe apical segments in high resolution computed tomography. There were focal peribronchial thickenings and ground glass density in right middle lobe. ARB was negative in bronchoalveolar lavage (BAL) and bronchial aspiration fluid. BAL fluid revealed 56% alveolarmacrophages, 30% lymphocytes, 12% PNL, 2% eosinophils. Non-diagnostic findings were observed in transbronchial lung biopsy. Since these tests were non-diagnostic, open lung biopsy was performed. Microscopic histopathological examination revealed scattered granuloma with caseification necrosis compatible with pulmonary tuberculosis. A few tuberculosis bacilli were detected in granuloma by Ziehl-Neelsen staining. The case was presented for atypical radiological findings imitating interstitial lung disease

Capture of Submicron Particles in Magnetized Granular Filled Beds

The diffusion separation of micron and submicron sized particles was examined theoretically in the gradient magnetic field formed by tangent ferromagnetic spheres magnetized in external homogeneous magnetic field. In the gradient field around the tangent points of the magnetized spheres, the analytical solution of the diffusion equation for steady states is obtained by using the expression of the magnetic force acting on the submicron-sized particle. The concentration distribution of the particles in these regions was calculated. An analytical formula has been developed to evaluate the critical dimensions of the diffused particles considering the magnetic, hydrodynamic, temperature and geometric parameters of the system. According to the results obtained, it was observed that the critical magnetic dimensions of the particles decreased with increasing external magnetic field. It is emphasized that this decrease can be up to the singledomain structure of the particles. According to the analytical calculations, the critical dimensions of the particles were found to be independent of the dimensions of the spheres. However, in the diffusion events occurring in the gradient magnetic field formed by ferromagnetic spheres, the critical dimensions of the particles are independent of the dimensions of the matrix element spheres was said to be discussable

Bir Üniversite Yerleşkesinde Uzun Süreli Elektromanyetik Alan Ölçümleri ve Kirlilik Haritaları

İnönü Üniversitesi yerleşke alanında bulunan baz istasyonlarının ve kampüs yerleşkesi üzerine etki eden diğer çok yüksek frekanslı elektromanyetik alan kaynaklarının yaydığı elektrik alan şiddetlerinin dönemsel ve uzun süreli ölçümleri yapılmış, yerleşkenin frekans bazlı elektromanyetik alan yoğunluk haritaları çıkarılmıştır. Elde edilen ölçüm sonuçlarına göre dönemsel değişimler kıyaslanarak sonuçlar değerlendirilmiştir. 2011 yılında 27 MHz-3GHz frekans aralığında spektrum analizi yapılarak yerleşke dâhilinde 450'nin üzerinde noktada, farklı frekanslara sahip elektromanyetik dalgaların alan şiddeti değerleri ölçülmüştür. 2013 yılında 100 kHz-8 GHz frekans aralığında anlık ölçümler ile 6700'ün üzerinde noktada elektrik alan şiddeti değerleri ölçülmüştür. Elde edilen sonuçlarla, elektromanyetik alan kirlilik haritaları çizilmiş ve sonuçlar değerlendirilmiştir. Çalışmanın amaçlarından biri iki yıllık periyotta üniversite yerleşkesinde elektrik alan şiddetinin değişiminin belirlenmesidir; bir diğer amacı da ölçüm sonuçlarından elde edilecek verilerle çizilen elektromanyetik kirlilik haritaları ile bu bölgedeki elektrik alan kaynaklarının homojen dağılımının sağlanması ve olası risk bölgelerinin belirlenmesidir

Evaluation of the two bundles of the anterior cruciate ligament with 1.5 tesla magnetic resonance imaging

Objectives: Studies on the anatomy of the anterior cruciate ligament (ACL) have shown that the normal ACL consists of two functional bundles named as anteromedial (AM) and posterolateral (PL) bundles. In this study, we evaluated the AM and PL bundles of the ACL using 1.5 tesla magnetic resonance imaging (MRI), which is routinely used in clinical practice. Methods: The study included 150 patients (96 females, 54 males; mean age 33.4±11.6 years; range 18 to 59 years) who did not have any signs of ACL insufficiency and whose knees were examined by MRI for other reasons. Standard magnetic resonance images (77 right, 73 left) were evaluated independently by an orthopedist and a radiologist in terms of distinguishable ACL bundles. The angle between the ACL (and each bundle) and the tibial plateau was measured on sagittal and coronal sections. Arthroscopic surgery was performed in 64 patients (42.7%) for primary diagnoses and arthroscopic and MRI findings were compared. Results: Magnetic resonance imaging showed an intact ACL in all the patients. The ACL was assessed as a single bundle in the axial, coronal, and sagittal planes in 93 patients (62%). A doublebundle appearance was noted in 57 patients (38%), involving all three planes in 14 patients (9.3%), axial and coronal planes in 41 patients (27.3%), coronal and sagittal planes in one patient (0.7%), and only coronal plane in one patient (0.7%). On MRI sections showing a single bundle ACL, the mean angle between the ACL and the tibial plateau was found as 55.3° in the sagittal plane, and 70.3° in the coronal plane. On sections with a double-bundle appearance, the mean angles between the AM bundle and the tibial plateau were 70.1° and 55.1° in the coronal and sagittal planes, respectively. The corresponding angles for the PL bundle were 81° and 53.5°. The incidence of double bundle ACL appearance in coronal, sagittal, and axial MRI sections was not influenced by sex and side (p>0.05). The number of bundles identified in each plane did not show a significant difference between the two observers (p>0.05). During arthroscopic surgery, both bundles were identified with normal integrity and function of the ACL in all the patients. Of these, MRI could depict a double-bundle appearance in one or more planes in only 42.2% of the patients. Conclusion: Even though standard 1.5 tesla MRI, routinely used in clinical practice, has a very high success rate in demonstrating the ACL, it can visualize the two-bundle structure only in about one-third of the patients

Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy.

Background There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progression under CDKi. In addition, we aimed to show the effectiveness of systemic treatments after CDKi and whether there is a survival difference between hormonal treatments (monotherapy vs. mTOR-based). Methods A total of 609 patients from 53 centers were included in the study. Progression-free-survivals (PFS) of subsequent treatments (chemotherapy (CT, n:434) or endocrine therapy (ET, n:175)) after CDKi were calculated. Patients were evaluated in three groups as those who received CDKi in first-line (group A, n:202), second-line (group B, n: 153) and >= 3rd-line (group C, n: 254). PFS was compared according to the use of ET and CT. In addition, ET was compared as monotherapy versus everolimus-based combination therapy. Results The median duration of CDKi in the ET arms of Group A, B, and C was 17.0, 11.0, and 8.5 months in respectively; it was 9.0, 7.0, and 5.0 months in the CT arm. Median PFS after CDKi was 9.5 (5.0-14.0) months in the ET arm of group A, and 5.3 (3.9-6.8) months in the CT arm (p = 0.073). It was 6.7 (5.8-7.7) months in the ET arm of group B, and 5.7 (4.6-6.7) months in the CT arm (p = 0.311). It was 5.3 (2.5-8.0) months in the ET arm of group C and 4.0 (3.5-4.6) months in the CT arm (p = 0.434). Patients who received ET after CDKi were compared as those who received everolimus-based combination therapy versus those who received monotherapy ET: the median PFS in group A, B, and C was 11.0 vs. 5.9 (p = 0.047), 6.7 vs. 5.0 (p = 0.164), 6.7 vs. 3.9 (p = 0.763) months. Conclusion Physicians preferred CT rather than ET in patients with early progression under CDKi. It has been shown that subsequent ET after CDKi can be as effective as CT. It was also observed that better PFS could be achieved with the subsequent everolimus-based treatments after first-line CDKi compared to monotherapy ET