Paraplegia associated with combined spinal-epidural anaesthesia caused by preoperatively unrecognized spinal vertebral metastasis

We describe a case of paraplegia following combined spinal-epidural anaesthesia. It was postoperatively determined that a tumour of the vertebrae which was compressing the spinal cord was responsible for this complication. We suggest that the pre-existing pathology of the spine must be borne in mind as a differential diagnosis of acute postoperative paraplegia.

Evaluation of the patellofemoral joint with kinematic MR fluoroscopy

OBJECTIVE

The aim of this study was to evaluate the diagnostic effectiveness of kinematic magnetic resonance fluoroscopy (KMRF) on patients with patellofemoral incongruency. MATERIALA AND METHODS: 17 patients (20 knees) and 10 healthy volunteers (20 knees), all men (mean age 29.4 years, S.D. 9, range 16-50), were included to our study. Only male subjects were studied because of potential biomechanical differences between sexes. KMRF was used to perform kinematic MR imaging of patellar alignment and tracking in 10 healthy subjects and 17 patients with a provisional clinical diagnosis of abnormal patellofemoral joints. The patellofemoral joints were examined with the knee in different angles of active flexion. At each knee position, real time kinematic and axial MRF image was used to focus on the sagittal plane, followed by an axial image focused through the middle of the patella. Three angles were measured: patellar tilt angle (PTA), sulcus angle (SA) and congruence angle (CA).

RESULTS

Five patterns of malalignment were identified and studied. Two patellofemoral joints were normal, 10 had lateralization of the patella, 2 had patellar tilt, 2 had lateralization and patellar tilt (i.e. excessive lateral pressure syndrome) and 4 had medialization of the patella.

CONCLUSION

KMRF is an effective method in evaluating patellofemoral incongruency. Short time duration of investigation, ability to get nearly real time images, suitable temporal contrast resolution and investigation from very different angles of knee are important advantages of the method.

Investigation of influence of tungsten mine wastes on the elemental composition of some alpine and subalpine plants on Mount Uludağ, Bursa, Turkey

In this study, the effect of mine work wastes on elemental composition (N, P, Ca, K, Mg, Fe, Mn, Cu, Zn) of some alpine and subalpine plant species and in soils were investigated in the surroundings of the Etibank Wolfram Mine Work in Uludag mountain. Soils and plant parts belonging to Thymus praecox Opiz., Acinos alpinus (L.) Moench, Plantago holosteum Scop and Festuca punctoria Sm species collected from three directions around Wolfram Mine Work were used for our investigations. All samples were analysed by flame atomic absorption spectrophotometer (FAAS) for Ca, K, Mg, Mn, Fe, Zn, and Cu. The significant differences among sample sites were in terms of pH, % CaCO3, % C, % N and % P contents of soil. The changes of Ca, Mg, Fe, Mn, Fe, Zn, and Cu contents in soil were determined to be due to mining activity. Of the four species examined, an important change was determined in concentrations of Mg, Mn, Fe and Zn although P. holosteum and F. punctoria were different in above- and below-ground parts, showing that plant element content is specific to species.

Fate of pesticides in soil in a coastal lagoon area and associated water quality impacts

Pesticides used on agricultural lands are among the significant diffuse sources of pollutants. They are poisons and can be particularly dangerous when misused and/or applied without care. Although certain characteristics of pesticides are well known, their final characteristics after they reach a waterbody are extremely difficult to estimate. Regarding the soil and water environment, it is necessary to conduct both a field study and laboratory analysis. Such a study has been performed in the catchment area of Dalyan Lagoon, Turkey, joining the Mediterranean Sea, that was selected as the pilot region. The input of pesticides, transport in soil and transfer to the water environment together with their probable impacts on water quality are determined by conducting detailed field surveys and water residue analyses. Within the scope of the study, the behavior and fate of pesticides both in soil and water are investigated in detail. Water residue experiments are conducted on four sets of water samples representing the seasons of the year 1999-2000 for the pre-selected 6 pesticides. Two sets of water samples (surface and bottom) are taken from the 16 stations along the lagoon channel and two lakes within the catchment area. The results and findings show the significance of the use of pesticides as they exist in the water environment around and/or slightly above the limits stated in the national current regulations except dichlorvos which presents very high values compared to its tolerance limit. Of particular interest, the results are used to enlighten the farmers and the public and increase awareness of pesticides as contaminants in valuable coastal waters.

Primary tuberculosis in the gluteal muscle of a patient with chronic renal failure. A rare presentation

Patients suffering from chronic renal failure (CRF) are at increased risk for contracting tuberculosis (TB) due to their impaired immunity. In this patient group, extrapulmonary involvement is more common than the pulmonary form of TB, and symptoms tend to be milder and less distinctive than those seen in the general population. Pyomyositis secondary to TB is relatively rare. We report a case of TB pyomyositis in the setting of CRF. The nonspecific symptoms that are typical of CRF patients with TB make it particularly difficult to establish the diagnosis in this patient group. In order to avoid diagnostic delays, which may increase the risk of complications and mortality, TB should be kept in mind in any case of ongoing fever and infection that does not respond to seemingly appropriate therapy. In addition, TB should always be suspected in endemic areas, even in the absence of osseous involvement.

Brucellar spondylodiscitis: MRI diagnosis

Early diagnosis of brucellar spondylodiscitis is often difficult because of the long latent period. Radiographs of the spine, bone scan, and computed tomography (CT) scan provide insufficient data. Among 25 patients with brucellar spondylodiscitis studied by magnetic resonance imaging (MRI), 9 were in the acute stage and 16 were in the chronic stage. MRI is the investigation method of choice in diagnosing brucellar spondylodiscitis.

[Treatment of intertrochanteric fractures in elderly patients with Leinbach type endoprostheses]

Intertrochanteric fractures are seen in elderly ages and occur mostly by minor trauma. Mortality and morbidity rates are high and internal fixation and external methods are used for the treatment. Twenty-seven patients with intertrochanteric fractures who were at the mean age of 78 ranging between 71-95 and were treated by Leinbach type endoprosthesis during 1995-1999 were evaluated. Fourteen (%51) patients were female and 13 (%49) were male. The patients underwent operation as early as they were convenient. If they could, they were advised to walk at the second or third day of the operation. Two (%7) patients died at the end of the operation and 1 (%3.7) patient died during the first week after the operation. The patients were followed up mean 14(5-21) months and evaluated according to the criteria of American Academy of Orthopedic Surgeons which displayed good results in %80 of patients. In elderly patients with intertrochanteric fractures due to pathologies and related complications and also complications due to immobilization are seen frequently. Treatment with endoprosthesis is thought to be helpful in decreasing these complications and early mobilization of the patients.

Treatment of traumatic bone defects by bone transport

This study retrospectively evaluates the results of the management using the callus distraction method, of 19 patients who had developed bone defects following acute trauma. Sixteen patients were males, with a mean age of 19.4 years (6-41 years). Thirteen patients developed bone defects as a result of high-velocity gunshot injuries, and six had defects caused by traffic accidents. The location of 12 fractures was the tibia, and seven were in the femur. The mean follow-up period was 23.6 (12-40) months. The mean length of the bone defect was 6.8 cm (4-16 cm), the distraction index was 13.3 days/cm (7.5-18 days/cm) and the external fixation index was 36.6 days/cm (32.5-46 days/cm). Fifteen (9%) pintract infections were observed among those who underwent circular external fixation and four (10%) in cases who underwent unilateral external fixation. There were no deep infections. Refracture was noted in one patient (5%), and two (11%) had delayed union at the target site. One patient developed nonunion at the target site. For the treatment of large bone defects, the callus distraction method may be an alternative option to conventional treatment methods.

Functional and radiological impairment in women highly exposed to indoor biomass fuels

OBJECTIVE

The aim of this study was to describe the lung function and the computed tomographic features in a selected group of non-smoking women with chronic obstructive pulmonary disease and biomass fuel exposure.

METHODOLOGY

Thirty female patients currently exposed to biomass smoke were prospectively investigated for further evaluation using high resolution computed tomography (HRCT), pulmonary function tests and blood gas analysis.

RESULTS

The mean age was 59 +/- 11 years. The patients were exposed to biomass smoke for 37.4 +/- 10 years. Pulmonary function tests revealed severe obstruction. The most common HRCT findings were increased lung volume or diffuse emphysema, thickening of interlobular septae, focal emphysematous areas, increased cardiothoracic ratio, and increased bronchovascular arborization.

CONCLUSION

Biomass fuel has deleterious effects on pulmonary function and structure leading to obstructive and restrictive pathologies.

Evaluation of diaphragmatic movement with MR fluoroscopy in chronic obstructive pulmonary disease

The aim of this study was to show reduction of the diaphragmatic excursion with MR fluoroscopy in patients with chronic obstructive pulmonary disease (COPD) and to compare the results with pulmonary function test (PFT). The study included 13 men and 10 women (average age 56.2) with COPD, and 9 men and 6 women (average age 55.8) as a control group. MR fluoroscopy images with Spoiled Gradient-echo pulse sequence was obtained during deep inspiration and expiration. After examination, over cine-loop display, the highest and lowest positions of the diaphragm were identified and the distance of excursion was measured. Differences in the diaphragmatic excursion between patient and healthy subjects were compared. We have also compared MR fluoroscopy results with PFT. In each person of both groups, excursion of the diaphragm was demonstrated clearly in cine-loop display. Differences of excursion between deepest and highest point of diaphragm were on average 26 and 20 mm, respectively, in the right and left side in patients and 69 and 56 mm in healthy group. Significant correlation was found between expiratory volume in 1 s and MR fluoroscopy results. MR fluoroscopy study showed that there were significant statistical differences in diaphragmatic excursion between patients with COPD and healthy subjects. Expiratory volume in 1 s is closely associated with the diaphragmatic excursion. MR fluoroscopy would seem to be a useful method for showing diaphragmatic excursion.

Metacarpal lengthening by distraction osteogenesis in childhood brachydactyly

Metacarpal lengthening was performed by callus distraction in six children with brachydactyly. Four of the patients were girls and two were boys, with ages ranging from 10 to 14 years (mean age: 12 years). Four of the patients had brachydactyly resulting from injury to the hand and damage to the epiphysis related to infection, while the other two had congenital brachymetacarpia. Two patients had short thumbs, two had short index fingers, and the remaining two had short ring fingers. General anesthesia with a pneumatic tourniquet was used during surgery for all patients. Distraction was initiated on the sixth day following osteotomy, and distractions of 0.25 mm were carried out at 12-hour intervals. Adequate length was achieved in an average of 37 days (32-44), and adequate union of the bone in an average of 12.2 (11.5-15) weeks. No bone grafting was done. In one patient with congenital brachymetacarpia, it was not possible to achieve the desired length because of bending in the Kirshner wires, but union of the bone occurred without difficulty, and the outcome was satisfactory. Although single-stage metacarpal lengthening by callus distraction is time-consuming, it is a simple procedure without complications, which can be used in children with brachydactyly.

Popliteal artery injuries associated with fractures and dislocations about the knee

The authors present the results of a retrospective review of popliteal artery injuries associated with fractures and dislocations about the knee. They treated 41 patients with popliteal artery injuries associated with either fractures about the knee or knee dislocations. Thirty-five of the patients were males, 6 females; the mean age was 23 years. The delay before accessing the hospital was 17 hours (range: 3 hours to 10 days). Thirty-two fractures were open. Together with the vascular injury, 12 femoral fractures, 20 tibial and fibular fractures, 5 knee dislocations, 4 femoral + tibial fractures were identified. Twenty-three patients underwent external fixation, 8 internal fixation, 6 plaster cast immobilization, 4 minimal osteosynthesis and plaster cast immobilization. The arterial injury was treated by end-to-end anastomosis in 5 cases, saphenous vein anastomosis in 29 cases and thrombectomy in 7 cases. Nine patients were amputated. Delay in surgery, blunt trauma, extensive soft tissue defect and bone fracture or dislocation, are associated with high amputation rate following popliteal artery injury. The influence of each of these factors alone on the amputation rate could not be evaluated in this study, as no statistically significant correlation could be demonstrated.

[The middle period outcome of partial patellectomy for the treatment of comminuted patella fractures]

The fracture of the biggest sesamoid bone patella is encountered at a rate of 1% of all skeletal injuries. Partial patellectomy is advised in the treatment of comminuted fractures of patella. In this retrospective study, we evaluated 18 of 25 patients who had partial patellectomy in our clinic between 1986-1997. Five patients were female (%27.8) and 13 were male (%72.2). The mechanisms of injuries were as follows: 11 (%61) motor vehicle accidents; 4 (%22) falls from flat-roofed house; 2 (%11) gunshot; and 1 (%5) subsidence. The mean age of the patients was 34.3 (range, 13-65). Ten left (%55) and eight right (%45) partial patellectomy were performed. Ten (%55) patients had also additional pathologies. The median follow-up time was 5.2 years (range, 2-11 years). Patients were very well in the last follow-up. According to Cincinnati Knee Score, which was improved by Noyes, 5 patients (%30) had excellent, 8 (%42) good 3(%17) moderate and 2 (%11) bad results. In conclusion, in the following years, enlargement in patellar articular surface and ossification, which is developed compensationally in the extensor mechanism may be detected and misevaluated as osteoarthrosis. Hence, we determined that they had not restricted knee joint functions in our cases.

Interferon therapy in haemodialysis patients with acute hepatitis C virus infection and factors that predict response to treatment

In view of the high rate of chronicity of acute hepatitis C and the low efficacy of interferon (IFN) treatment in advanced liver disease, it may be beneficial to treat patients during the acute phase of the infection. Here we assessed the effects of variable-dose IFNalpha-2b treatment in haemodialysis patients with acute hepatitis C virus (HCV) infection, and identified factors that may predict response to this therapy. The study population included 67 patients, but 14 were excluded due to side-effects or because they were lost to follow-up. Seventeen patients who received no specific treatment were used as controls (Group 1). Sixteen and 20 patients received low-(3 MU) and high-dose (6-10 MU) IFNalpha-2b three times weekly for 3 months (Groups 2 and 3, respectively). Virological end-of-treatment response (ETR) was observed in 1 (5.6%), 13 (56.5%), and 17 (65.4%) patients in Groups 1, 2, and 3, respectively, and virological sustained response (SR) was observed in 1 (5.6%), 6 (26.1%), and 13 (50%) patients in the three groups. The rates of virological ETR and SR in the treated groups were significantly higher than those of the control group (P < 0.01 for all comparisons). In multivariate logistic regression analysis, single stranded confirmational polymorphysm (SSCP) band number (P=0.02) was the only factor that was significantly associated with virological SR. In conclusion, IFN-alpha treatment initiated during the acute phase of HCV infection is associated with a higher rate of virological ETR and SR. This study suggested that quasispecies heterogeneity has predictive value with regard to virological SR.

Chiasmatic glioblastoma of childhood. A case report

A 6-year-old girl presented with visual deterioration that had progressively worsened over 2 months. MR imaging revealed a sellar, para- and suprasellar lesion. Subtotal tumor resection was performed. Histopathological diagnosis was glioblastoma of the optic chiasma. Chiasmatic glioblastoma is rare in adults and extremely uncommon in children. Surgical resection implies a risk of severe endocrinologic and ophthalmologic complications.

Power Doppler scanning in the diagnosis of carotid body tumors

The aim of this work was to show contribution of power Doppler imaging in the diagnosis of the carotid body tumors. Six patients with a nontender mass beneath the mandibular angle were evaluated with gray scale and power Doppler sonography. Well-defined, solid, weakly hyperechoic masses were noted on gray scale sonography in the carotid bifurcation. Power Doppler sonography showed abundant flow, characterized as an intense blush, throughout the entire tumor in all patients. We believe that invasive and expensive diagnostic modalities are not necessary to evaluate carotid body tumors. Gray scale sonography and power Doppler imaging are sufficient for primary diagnosis of carotid body tumors.

Power Doppler sonography in the diagnosis of Graves' disease

In addition to color and pulsed Doppler sonography findings, we aimed to describe power Doppler sonography findings in Graves' disease in this study. Twenty-three patients with Graves' disease were imaged with gray-scale, color and power Doppler sonography. Twenty normal volunteers were examined by the same equipment and the same technique as a control group. A subjective grading system was used to categorize the vascularization in pulsed Doppler sonography images from normal to markedly increased vascularization. Power Doppler sonography exhibited diffuse hypervascularity in the thyroid gland in all patients. The flow was covering about all the parenchyma. Four patients showed mild, 12 patients moderate and seven patients marked vascularity. The intensity of power Doppler flow pattern was not correlated with the severity of the disease. This study demonstrated that power Doppler sonography is a convenient, time saving, inexpensive and noninvasive method as compared with isotope scan and some other laboratory tests for confirmation of Graves' disease.

Effectiveness of human amnion preserved long-term in glycerol as a temporary biological dressing

Human amnion as a temporary biological wound dressing has remained a beneficial and cost-effective means of treating burns in developing countries. The aim of this study was to determine whether human amnion that has undergone long-term preservation in glycerol is an effective biological dressing compared to fresh amnion and glycerol-preserved human skin. Samples of human amnion and skin were preserved in sterile containers of 85% glycerol at 4 degrees C for over a year. Dorsal full-thickness or split-thickness skin wounds were produced in rats. The defects were divided into four areas, each of which was covered with preserved amnion, fresh amnion, preserved skin, or left uncovered as a control. The materials on the wounds were evaluated macroscopically and microscopically after 2, 4, 7, 10 and 14 days. The primary take or adherence of the grafts on full-thickness wounds was evaluated at 4 and 7 days, and material performance was scored based on several macroscopic and microscopic criteria. The bacteria levels reducing effect of the materials were examined by quantitative bacteriology in heavily infected full-thickness scald burn wounds of rats. Qualitative cultures confirmed that the storage conditions the materials were subjected to for over a year were aseptic and that the amnion and skin had maintained their characteristic properties. All materials were found effective on partial-thickness rat wounds as a cover under which re-epithelialization was completed by 7 days. The preserved skin performed better than either preserved or fresh amnion on full-thickness wounds but the performance of preserved amnion was comparable to that of fresh amnion. Glycerol-preserved amnion was found to be as effective as fresh amnion or skin in terms of decreasing bacterial levels in infected rat burn wounds. Amnion stored in glycerol is reliable and effective for a long period of time. Amnion banking could provide an unlimited quantity of biologic dressing for burn treatment at low cost, a factor that is particularly important in developing countries.

The club-shaped cord terminus in siblings with caudal agenesis: MRI

We report a rare instance of caudal agenesis occurring in siblings, with MRI. Both our patients had a club-shaped spinal cord, ending at T11. Radiological and urological findings are presented.

Duplex and color Doppler sonographic findings in active sacroiliitis

OBJECTIVE

The aim of this study was to describe the duplex and color Doppler sonographic findings in active sacroiliitis.

SUBJECTS AND METHODS

Forty-one joints in 21 patients with active sacroiliitis, 20 sacroiliac joints in 10 patients with osteoarthritis, and 30 sacroiliac joints of 15 asymptomatic volunteers were investigated on duplex and color Doppler sonography. We investigated whether a vessel was present around the posterior portions of sacroiliac joints with color Doppler sonography. When an artery was detected, the resistive index (RI) was measured using duplex Doppler sonography in all groups and also after treatment in the patients with active sacroiliitis.

RESULTS

Vascularization around the posterior portions of sacroiliac joints was seen in 41 joints of the 21 patients with active sacroiliitis, nine joints of six patients with osteoarthritis, and 13 joints of eight volunteers. The mean RI values were 0.62 +/- 0.13, 0.91 +/- 0.09, and 0.97 +/- 0.03, respectively. In the patients with active sacroiliitis, the mean RI value was 0.91 +/- 0.07 after therapy. The RI values for the patients with active sacroiliitis were significantly different from those of the patients with osteoarthritis (p < .001) and of the volunteers (p < .001). In addition, the RI values were significantly different before and after treatment in the patients with active sacroiliitis (p < .001).

CONCLUSION

Vascularization around the posterior portions of sacroiliac joints increased and RI values decreased in patients with active sacroiliitis. Color and duplex Doppler sonography were able to reveal these changes and can be used in the diagnosis of active sacroiliitis and follow-up after treatment. Thus, RI values may be a quantitative indicator for clinical symptoms in patients with active sacroiliitis.

Polyostotic fibrous dysplasia with craniofacial localization presenting with frontal lobe compression in a 14-year-old girl

We describe a rare case of polyostotic fibrous dysplasia with craniofacial localization associated with involvement of the spine and extremities. A 14-year-old girl presented with progressive headache, left frontal swelling, exophthalmos of the left eye, deformity and palpable mass in the left frontal area. Cranial computerized tomography revealed extensive involvement of all cranial bones except right frontal and right parietal bones. Most of the facial bones were invaded. Especially, there was the involvement of ethmoidal air sinuses and frontal sinus also. Computerized tomography showed left frontal lobe compression. In addition, the spine and bones of the extremities were involved in the patient. Craniofacial approach was planned. Cranial surgery was performed by an extradural frontal approach. Firstly, the frontal cyst was excised. For left frontal lobe decompression, we removed successfully all the abnormal bones causing mass effect and frontal deformity. Secondly, facial surgery was performed with external approach. An attempt to remove all of the involved bone is necessary, as the lesion may recur and grow if a portion of dysplastic bone is left in place. However, the present case suggests that removal of all the involved bones in the polyostotic fibrous dysplasia may be possible in spite of extensive involvement. In this situation, it may be removal of only abnormal bones responsible for compression of affected neural elements is indicated.

Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery

Chronic rhinosinusitis endoscopic surgery requires an accurate evaluation of diseases and paranasal sinus anatomic variations. This study aims to show the main anatomical variations in the ostiomeatal complex and paranasal sinuses which are usually depicted by computed tomography (CT). CT scans obtained 2 mm thickness in axial and coronal plane from a series of 200 patients with chronic sinusitis were examined to determine the prevalence of anatomic variants. Anatomical variations determined were supraorbital recess in 6%, concha bullosa in 30%, sphenomaxillary plate in 17%, infra-orbital ethmoid cells (Haller's cells) in 6%, spheno-ethmoid cells (Onodi's cells) in 12%, pneumatization of the anterior clinoid process in 6%, carotid artery bulging into the sphenoid sinus in 8%, pneumatization of the uncinate process in 2%, paradoxical curvature of the middle turbinate in 3% and septal deviation in 36%. Level difference between the ethmoid roof and nasal vault was an average of 8 mm in right side and 9.5 mm in left side. Awareness of these different variations will help the rhinologic surgeon in his orientation during endoscopic surgical procedures.

Electrospray ionisation tandem mass spectrometry of poly

Evaluation of polymer end-capping reactions with the aid of electrospray ionisation tandem mass spectrometry techniques (ESI-MS(n)) allows characterisation of novel poly[(R, S)-3-hydroxybutanoic acid]-(a-PHB) telechelics, containing primary hydroxyl groups at both polymer chain ends. The chemical structures of individual mass-selected macromolecules of the well-defined a-PHB telechelics have been defined in this way, and fragmentation mechanisms have been proposed. Copyright 1999 John Wiley & Sons, Ltd.

The role of power Doppler sonography in the prenatal evaluation of fetal renal vasculature

This study was performed to determine whether power Doppler sonography is superior to color Doppler sonography in the depiction of the normal fetal intrarenal vasculature during pregnancy. Twenty-five fetal kidneys in 22 healthy fetuses between 22 and 40 weeks of gestation (mean 32.6 weeks) were studied with color and power Doppler sonography with a 3.75 MHz transducer. The efficacy of power and color Doppler sonography were compared in assessing fetal renal vasculature. Power Doppler sonography demonstrated diffuse "blush" in almost the entire cortex in 21 of 25 fetal kidneys, whereas it was demonstrated in half of the cortex in the other four kidneys. Color Doppler sonography failed to demonstrate a cortical blush in fetal kidneys. Power Doppler sonography has been shown to be superior to color Doppler sonography in the depiction of normal fetal intrarenal vasculature during pregnancy by demonstrating vascular blood flow better than color Doppler sonography.

The role of power Doppler sonography in the evaluation of superficial soft tissue abscesses

OBJECTIVE

To evaluate the efficacy of power doppler ultrasonography in depicting increased vasculature and hyperemia around the superficial soft tissue abscess.

MATERIALS AND METHODS

21 patients with soft tissue abscess were evaluated with gray scale imaging, color doppler sonography, power doppler sonography and computed tomography. In each case attempts were made using power doppler sonography to demonstrate any areas of increased vascularity around the lesion. The results were compared with computed tomographic findings.

RESULTS

Peripheral hyperemia and increased vasculature were demonstrated with power doppler sonography in 19 of 21 patients with soft tissue abscess. The hyperemic area demonstrated around the wall of the abscess by power doppler sonography was similar to the enhanced area shown by computed tomography performed after contrast administration.

CONCLUSION

Power doppler sonography shows increased vasculature and hyperemia in the wall of abscesses. Therefore, power doppler sonography can be used to assist with the diagnosis of superficial soft tissue abscess.

The role of power Doppler ultrasonography in the diagnosis of prostate cancer: a preliminary study

OBJECTIVE

To determine the role of transrectal power Doppler ultrasonography (PDU) in the diagnosis of prostate cancer.

PATIENTS AND METHODS

Thirty-six patients (mean age 66.4 years, SD 7.7, range 59-82) with possible prostate cancer, suspected from an abnormal digital rectal examination or elevated prostate specific antigen level, underwent transrectal ultrasonography, transrectal PDU and biopsy. The vascularity on PDU was graded on a scale of 0-2, where grade 1-2 was considered positive and grade 0 negative.

RESULTS

The vascularity was grade 2 in 11 patients, grade 1 in 11 and grade 0 in 14; 20 of the 36 (56%) patients had prostate cancer. Of the 22 patients positive on PDU, 18 had malignant disease and four benign; two of 20 patients with histopathologically confirmed malignancy had a normal PDU. The sensitivity of PDU was 90%, the specificity 75% and the positive predictive value 82%.

CONCLUSION

Focal hypervascularity on PDU was associated with an increased likelihood of prostate cancer. Although ultrasonography alone cannot detect all cancers, even using PDU, the technique appears to increase the sensitivity and to help identify appropriate sites for biopsy.

Treatment of closed femoral diaphyseal fractures with external fixators in children

From August 1992 to July 1996, 57 patients with closed femoral fractures were treated by external fixator in the Orthopaedic and Traumatology Clinics, School of Medicine, Dicle University. The technique was applied to children with closed femoral fractures. Their mean age was 6 (range 4-12) years old. The mean hospitalisation period was 8 (range 5-15) days. Fixators were removed on an average of 55 (range 38-79) days. The mean follow-up period was 18 (range 9-36) months. Pintract infection was observed in 3 and refracture in 1 patient. Infection was controlled with oral antibiotics and local dressing. An external fixator was applied to a patient in whom refracture developed. No patient had malunion, nonunion, or leg length discrepancy. We propose that external fixation in closed femoral shaft fractures of children could be a rational alternative mode of therapy, since it has some advantages and can be easily removed without undergoing a second round of anaesthesia.

Management of brucella endocarditis of a prosthetic valve

A case of chronic brucella endocarditis of a prosthetic valve is reported. The diagnosis of this infection was established by positive blood cultures and high brucella agglutination titre. The patient was successfully managed by combination of medical therapy (consisting of streptomycin, trimethoprim-sulphamethoxazole, rifampin and tetracycline) and surgery.

Cerebral Dermabacter hominis abscess

Dermabacter species are commonly isolated from the skin and other body sites but rarely show pathogenicity in humans. A case of Dermabacter hominis cerebral abscess is reported which presented as a contrast-enhancing intracranial mass in a renal transplant patient.

Free hydatid cyst only covered with germinative membrane disrupted from fibrotic capsule in the peritoneal cavity: a case report

Echinococcosis, an endemic disease on the Asian continent, is caused by ecinococcus granulosus and rarely ecinococcus alveolaris. Although it occurs frequently in the liver and the lung, it can be localized in all tissues and organs. The purpose of this study is to report a rare localization and the complication of hydatid cyst in the pelvis : it pushed forward and upward the urine bladder and there was bilateral hydroureteronephrosis causing uraemia because of outflow obstruction. To our knowledge, a similar case has not been published before in English literature.

Power Doppler findings in nasopharingeal angiofibroma

Juvenile nasopharingeal angiofibroma (JNA) is a rare, histologically benign but clinically malign hypervascular tumor localized in the nasopharynx which occurs exclusively in adolescent boys. There is no definite attitude towards etiology of angiofibroma. In diagnostics, besides epypharyngoscopy, computed tomography and magnetic resonance imaging are the primary diagnostic tests. Angiography is used for preoperative embolization. In this case report, we aim to demonstrate the vascularity of JNA with power Doppler sonography (PDS) and advanced vasculature was observed into tumoral lesion with PDS.

The role of power Doppler ultrasonography in the diagnosis of acute pyelonephritis

OBJECTIVE

To assess the ability of power Doppler ultrasonography (PDU) to detect acute pyelonephritis and to compare the findings from PDU with those from enhanced computed tomography (CT).

PATIENTS AND METHODS

Eleven patients (mean age 18.5 years, range 5-37) admitted to hospital with a clinical diagnosis of pyelonephritis were assessed with PDU and enhanced CT. the latter providing the reference method.

RESULTS

The imaging studies showed normal findings in three patients; a single focus of pyelonephritis was detected by CT in six, whereas a matching defect was detected on PDU in five, with PDU failing to detect an infective focus in one. Multifocal diffuse pyelonephritis was diagnosed correctly by enhanced CT and PDU in two patients.

CONCLUSION

Power Doppler ultrasonography had an overall sensitivity of 88% and complete specificity in the evaluation of patients with acute pyelonephritis.

The diagnosis by fine needle aspiration biopsy of hydatid cyst of the pancreas

We describe a case of pancreatic hydatid cyst in which the definitive diagnosis was made at fine needle aspiration cytology. The most common site of hydatid cyst is the liver (65%), followed by the lungs (25%). The hydatid cyst of the pancreas is rare since it accounts for less than 1% of the various sites of hydatid disease. The diagnosis may be difficult when the presentation is that of an unexplained epigastric mass or cyst, despite suggestive radiological and ultrasonographic features. Modern serology tests are positive in up to 80% of the abdominal hydatid cysts. It is mandatory to obtain a fine needle aspiration biopsy for definite diagnosis and for appropriate treatment planning. Surgical removal of the hydatid cyst still remains the most effective treatment.

Herniography and ultrasonography. A prospective study comparing the effectiveness of laparoscopic hernia repair with extraperitoneal balloon dissection

BACKGROUND

This study was designed to assess differences between pre- and postoperative herniography and ultrasonography in inguinal hernia performed laparoscopically with balloon dissection and mesh without suture.

METHODS

Pre- and postoperative herniographic and ultrasonographic findings were analyzed in ten consecutive patients. Postoperative ultrasonography was performed on the 3rd and 7th days and herniography was performed on the 7th day.

RESULTS

Following the operation both the herniography and ultrasonography were almost normalized to a great extent in nine patients. Overall, minimal impaired continence was recorded by herniography in one patient. Also, we detected nonspecific soft-tissue thickening at the operation site in ultrasonographic examination in four patients.

CONCLUSIONS

As for inguinal hernias, compared with other operative modalities of treatment, laparoscopic hernia repair with extraperitoneal balloon dissection and mesh without suture is a highly successful procedure and its minimal morbidity is well accepted by the patient.