Recurrent Pulmonary Microemboli Secondary to Primary Cardiac Hydatidosis

Primary cardiac hydatid cysts are rarely diagnosed and seldom rupture to lungs via pulmonary vein resulting in multifocal cystic lesions. We report a rare instance of an interventricular hydatid cyst. A 19-year-old patient was admitted with dyspnea and multiple homogenous opacities with different sizes in his chest X-ray and contrast enhanced thorax computed tomography. We considered recurrent pulmonary microemboli, although neither systemic embolisation nor intravascular cyst of pulmonary arteries was detected. Due to extensive distribution of the pulmonary cysts, only the cardiac cyst was taken surgically. The patient remains in our care without any pulmonary improvement despite appropriate medical treatment.

Prevalence of asymmetry of mamillary body and fornix size on MR imaging

BACKGROUND AND PURPOSE

Mamillary body and fornix asymmetry are frequent findings on MR imaging of the brain. We sought to determine the prevalence of asymmetry of the fornix and mamillary body on MR imaging in patients with or without seizures.

MATERIALS AND METHODS

MR images were retrospectively evaluated for asymmetry of the mamillary body and fornix in 178 patients who had a history of seizures, of whom 35 had suspected mesial temporal sclerosis (MTS). Additionally, 353 patients who had no limbic system pathology were reviewed. All patients were examined with spin-echo MR imaging, consisting of contiguous axial and/or coronal fluid-attenuated inversion recovery (FLAIR), T2-weighted, and sagittal T1-weighted imaging. Additionally, the patients with seizures had oblique coronal 3-mm T2-weighted, FLAIR, and 1.5-mm magnetization-preparation rapid gradient echo scanning through their temporal lobes.

RESULTS

In the patients who had no limbic system pathology or seizure history, 6.5% (23/353) had MR imaging evidence of asymmetric mamillary bodies and 7.9% (28/353) had asymmetric fornix size. Asymmetry of the mamillary body and fornix size was found in 37.1% (13/35) and 34.3% (12/35), respectively, of subjects with suggested hippocampal sclerosis. The prevalence of asymmetry of the mamillary body and fornix was statistically significantly higher in the patients with MTS (chi(2) test, P <.0001).

CONCLUSION

Although asymmetry of the mamillary bodies and fornices is highly associated with MTS, this could also be seen as a normal variation or congenital abnormality.

Predictive value of D-dimer and LDH levels in response to chemotherapy in metastatic colorectal cancer patients

14568

Background: Hemostatic activation is known to occur in malignant diseases and this may be associated with tumor progression and angiogenesis. D-dimer levels are elevated in lung, uterine cervix, prostate and colorectal cancer patients. We aimed to evaluate the association and predictive value of LDH and D-Dimer levels with chemotherapy response in metastatic colorectal cancer (MCRC) patients. Patients and Methods: Twenty-five chemotherapy-naive MCRC patients were enrolled into this study. Plasma CEA, CA19–9, D-Dimer and LDH levels were measured before and after 3 cycles of capecitabine + oxaliplatin combination chemotherapy. The comparison between groups were done by Wilcoxon W and Mann-Whitney U tests. Results: Median age was 58 years in 15 female, 10 male patients. All patients received Capecitabine 2,000 mg/m2/day orally on days 1- 14 + Oxaliplatin 130 mg/m2 intravenously on day 1 every 21 days. The chemotherapy response after 3 cycles of treatment were 2 complete response, 7 partial response, 8 stable disease and progressive disease in 8 patients. Plasma CEA, CA19–9, LDH and D-Dimer levels were not significantly different between two groups before chemotherapy (table). Plasma LDH and D-Dimer levels were significantly higher in progressive disease patients than patients with complete, partial or stable response after 3 cycles of chemotherapy, but plasma CEA and CA19–9 were not significantly different between these groups (table). Conclusion: We found that D-dimer and LDH levels dropped in responders while they increased in patients with disease progression. D- Dimer and LDH plasma levels decrease or increase after response and progressive disease, respectively, and can act as a predictive factor of the clinical outcome of the disease.

[Table: see text]

No significant financial relationships to disclose.

Outcome of metastatic colorectal cancer patients receiving second line chemotherapy in Marmara University Hospital

14588

Background: With the development of oxaliplatin and irinotecan, multiple effective regimens are now available in advanced colorectal cancer (CRC), both as first- and second-line treatment options. Exposure to all of the active drugs is effective in prolonging overall survival (OS) and time to progression (TTP). There are limited studies, if any, analyzing the outcome of second line chemotherapy in metastatic CRC in Turkey. Thus, we aimed to evaluate the outcome of second-line treatments in metastatic CRC patients. Methods: Among 173 patients with metastatic CRC who were given first line chemotherapy 106 (47 female, 59 male) were administered second line treatment after progression. All patients histologically confirmed colorectal adenocarcinoma with ECOG performance score of 2 or lower, and received second line therapy for metastatic CRC after experienced disease progression during or following treatment with first-line therapy were entered the study. The patients were evaluated clinically and radiologically after each three-cycle period, and chemotherapy was changed or stopped if the cancer has progressed. Age, gender, grade, chemotherapy type (combination vs single agent), lymphatic, vascular, and perineural invasion, were analyzed as prognostic factors. Results: At a median follow up of 10 (range 1–40) months from the start of second line chemotherapy median TTP and OS time were 5 and 16 months respectively. Median age was 62 years (range 27–89). After second line therapy 16% of the patient had objective response rate (0.9% complete responses plus 15.1% partial responses), 37.7% had stable disease resulting in a tumor control rate of 53.7%, and 46.2% had progressive disease. One-year progression free survival and OS rates were 15 % and 53.5%, respectively. No difference was seen in the survival of patients received combination or single agent second line chemotherapy (p=0.14). Overall, over 12% of the patients suffered from grade 3 or 4 adverse effects. In multivariate analysis histological grade (p=0.015) was the only independent prognostic factor for survival. Conclusion: The survival outcome and adverse effects of second line treatments in Turkish patients in our department with metastatic CRC is consistent with the worlds’ literature.

No significant financial relationships to disclose.

Epirubicin, cisplatin, oral UFT (ECU) combination chemotherapy in metastatic gastric carcinoma

15126

Background: Chemotherapy significantly improves survival in comparison to best supportive care in patients with metastatic gastric cancer. In patients for whom a three-drug-combination is considered as the treatment of choice, ECF (epirubicin, cisplatin and 5-FU as a continuous infusion) should be regarded as standard of care. Continuous 5-FU infusion may be replaced by oral fluoropyrimidines. Here, we aimed to evaluate treatment with epirubicin and cisplatin combined with oral UFT with leucovorin (ECU), replacing intravenous 5-FU infusion Methods: Fifty-three patients (17 female, 36 male) with metastatic gastric carcinoma received epirubicin, cisplatin, and oral UFT plus leucovorin in two outpatient chemotherapy clinics, in Istanbul. Epirubicin 50 mg/m2 and cisplatin 60 mg/m2 were administered on day 1; and UFT 300 mg/m2/day was administered in conjunction with oral calcium folinate at a fixed dose of either 45 or 90 mg/day in divided daily doses for 21 days continuously. The treatment was repeated every 3 weeks. The patients were evaluated radiologically for response after each three-cycle period. Age, gender, ECOG performance score (PS), primary cancer localization, and presence of primary curative surgery were analyzed for prognostic factors. Results: Median follow-up was 6 (range 1–12) months. Median age was 57 years (range 27–76). Patients received a median of three courses of treatment (range: 1–6). Over 86% of the patients had PS =1, whereas remaining 13% had PS 2. Forty-three percent of the patients were undergone curative surgery at the time of cancer diagnosis, while 57% presented as metastatic disease. The most frequent site of metastases was liver (42%). Twenty-five percent of the patients showed partial responses, while none showed a complete response. Over 28% of the patients had stable disease resulting in a tumor control rate of 53%, and 47% had progressive disease. Median TTP and OS were 6 and 8.6 months, respectively. In univariate analysis; having PS =1, and presence of primary curative surgery were independent prognostic factors (p:0.042, and p:0.019, respectively) Conclusion: ECU regimen has a significant activity in metastatic gastric cancer. It does not require an infusion pump and intravenous catheter.

No significant financial relationships to disclose.

Tuberculous sacro-ileitis: two cases and radiological findings

Infective sacro-ileitis is due to common bacteria, 25% being tuberculosis and 10% brucellosis. Slow progression characterizes joint tuberculosis, an uncommon variant of this disease. The onset is usually insidious, and early diagnosis requires a high index of clinical suspicion. We report two cases with tuberculous sacro-ileitis which initially mimicked brucellosis infiltration. Diagnosis of tuberculosis of the sacroiliac joint was established by fine-needle aspiration of joint and radiological imaging methods such as computerized tomography, magnetic resonance and three-phase bone scan. The current diagnosis and treatment of this condition is discussed based on these cases and a literature review.

Magnetic resonance imaging findings in diffuse lymphangiomatosis: neuroradiological manifestations

We report magnetic resonance (MR) findings in a patient with histologically proven lymphangiomatosis with a history of chylothorax, diffuse lung infiltrates, spinal involvement, cystic lesions of the mediastinum, and mesentery thickening. The patient also had diffuse infiltration of the right brachial plexus, with similar imaging findings as the spinal lesions. Although osseous and extraosseous involvement may be seen frequently with lymphangiomatosis, involvement of the brachial plexus has not been previously reported.

Multidetector Computed Tomographic Angiography Findings of Splenic Artery Steal Syndrome in Liver Transplantation

AIMS

Splenic artery steal syndrome, a common complication in liver transplantation, is diagnosed by conventional angiography showing an enlarged splenic artery and by dynamic findings. The aim of this study was to determine multidetector computed tomographic angiography (MDCTA) findings of splenic artery steal syndrome to develop diagnostic criteria.

MATERIALS AND METHODS

Ten patients were diagnosed as displaying splenic artery steal syndrome among 198 liver transplant patients. The diagnosis was confirmed by celiac angiography. In eight of them, MDCTA was performed. Axial and coronal maximum-intensity projection images were obtained in arterial and portal phases. We measured the diameter of the celiac trunk and of the splenic, left gastric, common hepatic, superior mesenteric artery, and transplant hepatic arteries. We also measured the diameter of the proximal and the distal segments of the abdominal aorta, along with the size of the spleen, the ratio of the splenic artery to the common hepatic artery, the ratio of splenic artery to transplant hepatic artery, the diameter of portal vein and superior mesenteric vein. The control group consisted of liver transplant patients with normal liver enzyme levels. We performed Student t test for statistical examination.

RESULTS

The diameter of the splenic artery (P<.05), the size of the spleen (P<.01), and the ratio of the splenic to the transplant hepatic arteries (P<.05) was significant between the two groups. The diameter of the splenic artery was larger than 4 mm in all patients in the study group.

CONCLUSIONS

Conventional angiography was mandatory for the diagnosis of splenic artery steal syndrome. MDCTA is a noninvasive method. Some computed tomography criteria are important for early diagnosis and treatment.

Clinical efficacy of a new software developed for dental digital subtraction radiography

OBJECTIVES

The aim of this study was to test and compare the efficacy of software developed recently for digital subtraction radiography (DSR) in vivo.

METHODS

An algorithm performing both manual and automated image reconstructions and contrast correction was developed for the manipulation of radiographic images. Pre- and post-operative radiographic images of ten patients were obtained and the automated subtraction analyses were performed using four different softwares (new software, Emago, Photoshop 8.0 and Paintshop Pro 9). Ten experienced dental specialists evaluated the clinical efficacy of each program and scored the softwares by using visual analogue scales (VAS). The results were statistically analysed and alpha was set as 0.05.

RESULTS

The newly developed algorithm received higher scores than the others (new software =67.89, Emago = 64.26, Paintshop Pro 9 = 33.41 and Photoshop 8.0 = 27.24, respectively). The clinical efficacies of the new software and Emago were not significantly different (P = 0.720); likewise, Photoshop 8.0 and Paintshop Pro 9 performed comparably (P = 0.295).

CONCLUSIONS

Considering this study, the new software and Emago would be suggested for DSR in dental practice.

Focal increased cortical density in immediate postembolization CT scans of patients with intracranial aneurysms

BACKGROUND AND PURPOSE

Cortical hyperdensity was observed in the immediate postembolization CT scans of some patients with intracranial aneurysms following uneventful endovascular treatments. The clinical significance and possible underlying mechanism were evaluated.

MATERIAL AND METHODS

Ninety-three consecutive patients with a total of 100 intracranial aneurysms, treated by endosaccular packing, were studied. Seventy-four aneurysms were treated with balloon assistance, and the remaining aneurysms were treated without balloon assistance. All patients underwent cranial CT just before and immediately after the endovascular treatment. If the post-treatment CT showed any new finding, an immediate MR imaging and a repeat CT 4-6 hours after the initial posttreatment CT were performed. Several parameters were investigated related to the presence of cortical hyperdensity.

RESULTS

Cranial CT showed focal cortical hyperdensity following the treatment of 40/74 aneurysms (54%) with balloon remodeling and 9/26 aneurysms (34.6%) without balloon assistance. None of these patients were symptomatic, and cortical hyperdensity resolved in the repeat CT scans. A statistically significant relationship was observed between the presence of this finding and the total amount of contrast material, microcatheter time, number of balloon inflations, and total balloon inflation time.

CONCLUSION

Immediate postembolization CT may show focal cortical hyperdensity following uneventful endovascular aneurysm treatment, most likely caused by blood-brain barrier disruption resulting in accumulation of contrast medium. The hyperdensity was more frequent when balloon assistance was used but was also seen in the patients with no balloon use. It is important to differentiate this clinically insignificant finding from possible hemorrhage, which would affect patients' immediate postprocedural medical management.

Radiological findings in a mumps case with multiple complications

Mumps is an infection caused by paramyxoviruses. This infection is more common among children and it progresses with a number of complications later in life. This case was found worth presenting because no cases with such a diversity of complications have been reported in English literature in the last 25 years. A 17-year-old male patient was admitted to the emergency unit with bilateral parotitis, meningoencephalitis and orchitis. The patient was clinically and serologically diagnosed as having mumps and developed an acute pancreatitis, arthritis in the left knee, cholestatic hepatitis and myocarditis in the follow up. Radiological imaging methods lead the way to the description of the complications.

Localized fluid collections after liver transplantation

BACKGROUND

Liver transplantation is an accepted effective therapy for patients with diseases that lead to hepatic failure. In addition to vascular, rejection-related, biliary, and lymphoproliferative complications, posttransplantation fluid collections, such as hematomas, seromas, bilomas, localized ascites, and abscesses can affect graft survival. In this study, we have presented, ultrasonography and computed tomography images as well as reviewed the literature.

METHODS

Between December 1988 and March 2005, 138 patients (94 men [68.11%], 44 women [31.89%] of mean age, 26.77 years (range, 1 to 64) underwent liver transplantation in our institution from living-related donors in 85 and deceased donors in 53 recipients. This retrospective study analyzed the fluid collections diagnosed after liver transplantation.

RESULTS

Among 138 liver transplants we identified 56 localized intra-abdominal fluid collections, including 46 hematomas, 4 bilomas, and 6 abscesses. Fluid collections were noticed between 0 and 1095 days (mean = 13.50 +/- 152.82 days). Thirty-three collections were identified in living-related, and 23 in deceased donor recipients. The collections showed an average volume of 375 cm3, with a range of 1 to 4368 cm3. Two cases of bilomas were related to hepatic arterial insufficiency, one from a hepatic artery occlusion and the other from a significant stenosis.

CONCLUSIONS

Localized intra-abdominal fluid collections were commonly seen after liver transplantations, diminished in size without treatment, but required aspiration or drainage in some patients.

An epidemiology study of patients with uremic pruritus

BACKGROUND

Pruritus is a common problem in continuous ambulatory peritoneal dialysis (CAPD) and haemodialysis patients. There are few studies on the clinical characteristics of uremic itch, the cause of which is still unknown.

OBJECTIVES

The aim of this study was to define the prevalence and clinical characteristics of pruritus in CAPD and haemodialysis patients.

METHODS

A questionnaire was used to evaluate pruritus in 52 CAPD and 289 haemodialysis patients in two dialysis units. The relationship of various factors and medical parameters to itch was examined.

RESULTS

Of the 341 patients, 177 (51.9%) had pruritus at the time of examination, 97 (28.4%) had pruritus in the past. Pruritus was present in 145 (50.2%) of the haemodialysis patients and 32 (61.5%) of the CAPD patients. Men, patients with liver disease, and patients with pruritus before starting dialysis treatment were more likely to have uremic pruritus.

CONCLUSIONS

This study showed us that uremic pruritus was observed more in men than women. The high prevalence of uremic pruritus in our study does not support the decrease of pruritus due to an improvement in the management of dialysis patients.

Risk factors associated with gallstone and biliary sludge formation during pregnancy

AIM

To define the risk factors in gallstone and sludge formation, and to investigate the incidence of gallstone and biliary sludge formation during pregnancy in a group of healthy pregnant women.

METHODS

Sixty-nine healthy pregnant women in early gestation and 28 nulliparous healthy controls were enrolled. Gallbladder volumes, gallbladder ejection fraction (GBEF), serum triglyceride and cholesterol levels were determined in both groups. In the pregnant group, repeated measurements were performed immediately after delivery and compared with initial levels. Risk factors, which are associated with gallstone and biliary sludge development during pregnancy, were determined by linear regression analysis.

RESULTS

No statistically significant difference was observed in the assessed parameters of pregnant women in early gestation and controls (both P > 0.05). In the pregnant group, gallstone and biliary sludge development during pregnancy were detected in 6.3% and 10.9% of cases, respectively. The detected parameters were significantly higher early after delivery than in early gestation, while GBEF was lower (both P < 0.001). Lower GBEF was the most significant factor (P < 0.001) associated with gallstone and sludge formation during pregnancy, while multiple childbirths was the other (P = 0.04).

CONCLUSION

Decrease in GBEF is the most significant risk factor for newly developed gallstone and sludge in pregnant women, while multiple childbirths is the other but less important risk factor.

Risk factors associated with gallstone and biliary sludge formation during pregnancy

AIM

To define the risk factors in gallstone and sludge formation, and to investigate the incidence of gallstone and biliary sludge formation during pregnancy in a group of healthy pregnant women.

METHODS

Sixty-nine healthy pregnant women in early gestation and 28 nulliparous healthy controls were enrolled. Gallbladder volumes, gallbladder ejection fraction (GBEF), serum triglyceride and cholesterol levels were determined in both groups. In the pregnant group, repeated measurements were performed immediately after delivery and compared with initial levels. Risk factors, which are associated with gallstone and biliary sludge development during pregnancy, were determined by linear regression analysis.

RESULTS

No statistically significant difference was observed in the assessed parameters of pregnant women in early gestation and controls (both P > 0.05). In the pregnant group, gallstone and biliary sludge development during pregnancy were detected in 6.3% and 10.9% of cases, respectively. The detected parameters were significantly higher early after delivery than in early gestation, while GBEF was lower (both P < 0.001). Lower GBEF was the most significant factor (P < 0.001) associated with gallstone and sludge formation during pregnancy, while multiple childbirths was the other (P = 0.04).

CONCLUSION

Decrease in GBEF is the most significant risk factor for newly developed gallstone and sludge in pregnant women, while multiple childbirths is the other but less important risk factor.

Late ultrasonographic findings in cases operated for hydatid cyst of the liver

PURPOSE

The aim of this study was to evaluate and present the images due to surgical intervention and to recurrences in patients who had been operated for hydatid cyst of the liver at least 12 months prior to the imaging process.

MATERIAL AND METHODS

A total of 77 patients (46 females, 31 males) with a mean age of 38 years (10-60 years) who had undergone surgical intervention for hydatid cyst of the liver were included in this study. The type and the number of operations were determined by reviewing previous medical records of the patients. Recurrence findings and postoperative images were examined by ultrasonography in all patients.

RESULTS

Of the 77 patients, 68 had undergone surgical operation for hydatid cyst of the liver for once, six cases for twice, one patient for three and another patient for four times. Ultrasonographic examination was considered normal in 9 (11.6%) patients. The most frequent finding in the remaining patients was hypoechoic (n=6) and anechoic (n=14) images with a hyperechoic periphery within the operation area. While a coarse heterogenous area was visualized in 12 cases (15.5%), a sole hypoechoic image was present in 10 patients. Recurrence was detected in 9 (11.6%) patients of whom 7 were asymptomatic. While daughter cysts were detected in two recurrent cases; the remaining were unilocular cysts. An omentum image extending to the operation area was detected in 11 patients. Calcification was present in 14 patients, whereas four cases had less common findings of anechoic tubular structures adjacent to the operation area.

CONCLUSION

While the liver may seem normal by ultrasonography in the late postoperative period in patients, who had been operated for hydatid cyst of the liver, various images may also be present. These images may be misinterpreted as recurrence or other pathologies. Thus, the radiologist should be familiar with the postoperative ultrasonographic findings of hydatid cyst and should not misinterpret the image of anechoic fluid as recurrence. When in doubt, ultrasonographic follow-up is essential. An early postoperative ultrasonographic examination may be the key point in precluding a misdiagnosis.

What defines the quality of patient care in tinea pedis?

OBJECTIVES

The aim of this study has been to evaluate patients with tinea pedis for their demographic data and attitudes affecting the treatment of disease, and to compare the in vitro activity of 10 antifungal agents and to relate them to their in vivo activity.

METHODS

Patients with positive mycological examination were enrolled in the study, and a questionnaire comprised of 22 questions was administered. A mycological culture was carried out for each specimen. The antifungal susceptibility of the subcultured species was determined for griseofulvin, terbinafine, ciclopiroxolamine, fluconazole, ketoconazole, itraconazole, bifonazole, sulconazole, oxiconazole and miconazole with microdilution.

RESULTS

Mycological cultures were carried out from 59 patients and there were 35 positive cultures (59.3%). The dermatophytes were Trichophyton rubrum (n = 25) and Trichophyton mentagrophytes (n = 3). The yeasts were Candida albicans (n = 7), Candida glabrata (n = 1) and Trichosporon (n = 2). In the minimum inhibitory concentration (MIC) study, the mean +/- standard error of the mean (SEM) MICs of the antifungals for T. rubrum were as follows: terbinafine 0.01 +/- 0.003, oxiconazole 0.16 +/- 0.05, sulkonazole 0.31 +/- 0.05, miconazole 0.45 +/- 0.15, itraconazole 0.74 +/- 0.01, ketokonazole 1.03 +/- 0.17, ciclopiroxolamine 1.30 +/- 0.12, bifonazole 1.94 +/- 0.51, griseofulvin 4.87 +/- 0.61, and fluconazole 17.91 +/- 3.67 microg/mL.

CONCLUSION

Our study supports that azoles could be used as first-line treatment, as oxiconazole is very effective for both dermatophytes and C. albicans. Correlation between in vitro results and clinical outcomes of cases of dermatophytes is still to be established and interpretive breakpoints defined, in order to increase the quality of patient care in tinea pedis.

Comparison of brucella and non-specific epididymorchitis: gray scale and color Doppler ultrasonographic features

OBJECTIVE

The aim of this study is to find out if it is possible to differentiate between brucellar and non-specific epididymorchitis by comparing ultrasonography (US) and color Doppler ultrasonography (CDUS) findings.

MATERIAL AND METHODS

Fifty-six patients diagnosed to have epididymorchitis both clinically and ultrasonographically were included to study. All of the patients were investigated serologically for brucella. Twenty-eight of those patients were admitted brucella epididymorchitis because of high agglutinations titers for brucella. The other 28 patients were admitted non-specific epididymorchitis because of normal agglutinations titers for brucella. Testicular size, echogenicity, hydrocele, internal echoes and/or septations within hydrocele, and scrotal skin thickness of normal and involved testis were compared by ultrasonography. Besides, pick systolic velocity, end diastolic velocity, resistive index and pick systolic velocity ratio values were measured by bilateral testicular color Doppler ultrasonography in both groups. When the p-value is <0.05, the difference between groups is accepted as statistically significant.

RESULTS

Thickening of scrotal skin was seen in 17 of 28 patients with brucella epididymorchitis (BEPO) (67%) and in 25 of 28 patients with non-specific epididymorchitis (NEPO) (89.2%) (p < 0.01). There was no difference between groups regarding presence of hydrocele. However hydrocele seen in all patients was anechoic except for two patients (8.6%). Hydrocele seen in 18 of 22 patients with BEPO and hydrocele had internal echogenicity or septation (p < 0.001). Sizes of testes and epididymis were found to be increased in involved testis compared to normal testis. Testes of all patients with NEPO were homogenous with decreased echogenicity except for five patients (17.8%). However, 23 patients with BEPO (82%) found to have heterogenous testis (p < 0.001). Spectral measurements showed increased PSV and EDV values and decreased RI values in involved sides in both groups. There was statistical significant difference in respect to maximum and minimum flow velocity between two groups (p < 0.05). There was no difference between the two groups regarding RI values. PSV ratio was 3.1+/-1.3 in patients with BEPO and 2.2+/-0.7 in patients with NEPO.

CONCLUSION

Heterogenicity, focal echogenicity differences and hydrocele with granularity and/or septation seen in a patient presenting with scrotal infection in brucella endemic areas must rise the possibility of brucellosis rather than NEPO. By this way, effective treatment can commence immediately and complications can be avoided.

Anteversion of the acetabulum and femoral neck in early walking age patients with developmental dysplasia of the hip

Computed tomography measurements were made to quantify the relationship between the anteversion of the acetabulum and femoral neck in 27 early walking age patients (age range; 18-48 months) with developmental dysplasia of the hip. The centre-edge angle and acetabular index were measured in standard pelvis radiographs, and anteversion of acetabulum and femoral neck were measured by use of two-dimensional computed tomography in 25 complete dislocated, 19 subluxated and 10 unaffected hips (a total of 54 hips). The diagnosis of dysplasia, subluxation and complete dislocation of developmental hip dysplasia were determined radiographically using Ishida's criteria. There were statistically significant differences between the three groups for the centre-edge angle, the acetabular index, and acetabulum anteversion. There was no statistically significant difference between the three groups for femoral neck anteversion. The acetabular anteversion was found to be 13.4+/-2.8 degrees (mean+/-SD) in unaffected hips, 16.7+/-1.9 degrees in subluxated hips and 19.8+/-2.5 degrees in complete dislocated hips. There was statistically significant difference between the three groups, with a wide range of acetabular anteversion values noted in all groups (9-26 degrees ). The acetabular anteversion was increased on the dislocated side in each patient and we found no retroverted acetabulum. On the other hand there was no significant difference between the groups with regards to femoral neck anteversion. We conclude that confirming anteversion of the acetabulum and the femoral neck by two-dimensional computed tomography is needed in treatment planning of early walking age patients with developmental hip dysplasia.

Microsurgical Landmarks for Safe Removal of Anterior Clinoid Process

OBJECTIVE

The microsurgical and radiological anatomy of the clinoid process were studied to give surgeons more details about the anterior clinoid process and its relations to the vascular and nervous neighbourhood during intradural and extradural clinoidectomy, thus making the operative procedures safer.

METHODS

Seven formalin-fixed (14 sides) and two fresh cadavers (four sides) were studied to reveal the surgical anatomy of the anterior clinoid process and related landmarks during intradural and extradural drilling techniques of clinoid process. Furthermore, aeration of the anterior clinoid process was investigated in 100 paranasal tomography (200 sides) scans.

RESULTS

Careful drilling of the anterior clinoid process is mandatory to avoid damage to the extremely important adjacent structures. The anterior clinoid process must not be removed in one piece. Clinoid folds and the frontotemporal fold should be exposed adequately. The falciform ligament must be cut to visualize the optic nerve and ophthalmic artery clearly. Preoperative radiological assessment of clinoid process variations should be done. In computerized tomography scans, pneumatization of the right anterior clinoid process was found in 12%, of the left anterior clinoid process in 7% and bilaterally pneumatization was present in 9%.

CONCLUSIONS

Removal of the ACP is one of the most critical procedures to the successful and safe management of ophthalmic segment aneurysms and tumors located in the paraclinoid region and cavernous sinus. Special attention should be paid to the anatomic landmarks indicating the relationship between the anterior clinoid process and adjacent structures. Beside that, pneumatization of the anterior clinoid process should be evaluated preoperatively with computed tomography to avoid complications such as rhinorrhea and pneumocephalus.

Interlocking nailing of humeral shaft fractures. A retrospective study of 114 patients

BACKGROUND

Fractures of the humeral shaft are relatively common injuries. Literature suggests that humeral shaft fractures represent approximately 3 % of all fractures. There are several modalities for the management of diaphyseal humeral fractures. The latest investigations emphasize the concept of minimal exposure and rigid fixation.

AIM

The aim of the study is to evaluate the results of antegrade intramedullary nailing in humeral shaft fractures.

DESIGN

A retrospective review.

SETTINGS

Patients were treated in private hospital settings by 3 orthopaedics surgeon.

MATERIAL AND METHODS

Between 1995 and 2003, the technique of antegrade locked intramedullary nailing with UHN in humeral shaft fractures was performed on 114 patients. Forty-two (36%) patients sustained multiple traumas, and 22 (19%) fractures were open. The outcomes were evaluated with a mean follow-up of 41 months.

STATISTICAL ANALYSIS USED

Ranges of results given.

RESULTS

In 109 fractures primary union observed. In the other five patients union achieved after removal of the nail and fixation with DCP and bone grafting. The average time for union was 13 weeks (range, 10-36 weeks). One hundred-five patients had excellent or satisfactory recovery of shoulder and elbow function. Complications included impingement due to proximal locking screws in two patients and prominent nail in three patients, transient postoperative radial nerve palsy in four patients.

CONCLUSIONS

This study shows that antegrade locked nailing in humeral shaft fractures are reliable and also effective in multiply injured patients.