Comparison of Two Segment Combined Instrumentation and Fusion versus Three Segment Posterior Instrumentation in Thoracolumbar Burst Fractures: A Randomized Clinical Trial with 10 Years of Follow Up

AIM

To compare the clinical and functional outcomes between combined anterior and posterior 2-segment spinal fusion and posterior 3-segment spinal fusion in patients with thoracolumbar (TL) burst fractures at risk for posttraumatic kyphosis without neurological deficit.

MATERIAL AND METHODS

Twenty-seven patients with TL burst fracture, > 20° kyphosis and/or 50% collapse, and posterior ligament injury, but without neurological deficit, were randomly assigned into posterior and combined groups. Posterior treatment was 3-segment (1 level below, fractured level and 2 levels above) posterior spinal fusion. Combined treatment was including 1 cranial and 1 caudal levels posterior spinal fusion, followed by anterior corpectomy, cage, and bone grafting. Patients were followed-up for a mean duration of 117.7 ± 8.7 months (range, 98-132 months). At the final follow-up, the clinical and functional means of the groups were compared using degree of kyphosis, visual analogue scale (VAS), and Roland-Morris and Oswestry scores.

RESULTS

Mean patient age was 38.5 ± 2.4 years (range: 18-68 years). Fourteen and 13 patients were treated with the combined and posterior approach, respectively. Age (40.0 ± 10.3 and 37.0 ± 14.2 years; p=0.519), sex (female/male, 3:10 and 5:9; p=0.385), mechanism of injury (p=0.513), fractured levels (p=0.185), type of fracture (p=0.293), degree of kyphosis at initial admission (p=0.616), collapse (p=0.155), canal narrowing (p=0.280), follow-up (p=0.076) and accompanied limb fracture (p=0.374) were similar between groups. Duration of hospital stay was similar between two groups (p=0.102). However, blood loss was higher in combined group (195 ml versus 358ml, p=0.003). A 14.2° correction was achieved in the posterior group and 16.9° in the combined group (p=0.61). Loss of correction at the last follow-up visit was 2.1° with a final kyphosis of 7.2° in the posterior group, and 1.2° with a final kyphosis of 5.5° in the combined group. The differences in the correction of kyphosis (p=0.616), postop kyphosis (p=0.756), loss of correction (p=0.141) and final kyphosis (p=0.085) between the treatment groups were not significant. At the last follow-up visit of the posterior and combined groups, the VAS (16.4 ± 14.8 vs. 17.6 ± 16.6; p=0.685), Roland-Morris (27.2 ± 27.3 vs. 29.6 ± 20.5; p=0.519), and Oswestry scores (15.0 ± 13.1 vs. 17.7 ± 11.5; p=0.302) were similar.

CONCLUSION

Both treatment methods are similar in terms of clinical and functional outcomes.

Deep Venous Thrombosis of the Extremity Diagnosed by Color Doppler Ultrasonography after Isolated Limb Perfusion

Aim

Isolated limb perfusion (ILP) is used to treat locally advanced sarcoma and melanoma of the extremities. ILP is associated with a 1.7% to 10% incidence of deep venous thrombosis (DVT). The aim of the study was to examine the effect of ILP on the peripheral venous system and to evaluate the diagnostic accuracy of color Doppler ultrasonography (US).

Methods

A total of 26 patients with locally advanced sarcoma or melanoma of the extremities received a total of 38 ILP. The patients were evaluated preoperatively and postoperatively by color Doppler US as a noninvasive venous measurement. We used a color Doppler US system (SSA-270A, Toshiba) with a 7.5-MHz linear transducer for gray-scale imaging and a 5-MHz vascular transducer for color Doppler imaging.

Results

Seventeen patients underwent single ILP while the others were treated with multiple ILPs. Color Doppler US showed a reflux flow in three (7.9%) patients and DVT occurred subsequently in these patients.

Conclusions

Color Doppler US is a noninvasive and clinically useful diagnostic technique in the diagnosis of extremity DVT. We recommend anticoagulant therapy in patients with reflux on ultrasonographic examination.

How olfaction disorders can cause depression? The role of habenular degeneration

The removal of bilateral olfactory bulbs (OBs) can result in serious behavioral, neurochemical, neuroendocrine, and neuroimmune alterations in depressed patients. However, there is little information on how olfactory bulbectomy (OBX) leads to depression. Habenular nuclei and their connections are important in the regulation of psychomotor and psychosocial behaviors through afferent impulses of the olfactory system. Therefore, we investigated whether OB lesions lead to habenular degeneration. We used a sample of 50 rats (25 female and 25 male) for this study. Of these rats, five male and five female rats were taken as the control group. The remaining 40 rats (20 male and 20 female rats) constituted the study group, and frontal burr holes were performed at the OB level on these rats. OB cauterization was applied to 10 male and 10 female rats (n=10, 10; study group 1), mechanical OBX was applied to five male and five female rats (n=5, 5; study group 2), and no procedure was performed on the remaining 10 rats (n=5, 5). The psychomotor movements; pregnancy rates; and sexual, feeding, maternal, social, and grooming behaviors for both study groups were observed daily for 3 months. Their OBs, olfactory cortices, and habenular complexes were examined using stereological methods. All of the animals in the study groups, especially in the cauterization group, demonstrated anorexia, nutritional disorders, weight loss, psychomotor retardation, sexual aversion, decreased grooming behavior, and reduced social interaction similar to depression symptoms. As compared to the control group, the pregnancy rates, number of offspring per mother rat, and birth weights in the study groups were lower, whereas the number of stillbirths was higher. Gross anatomical examinations revealed that the OBs of all of the animals in the study groups were atrophied. Histopathological examinations detected prominent neuronal loss due to apoptosis in the habenular structures in the study groups. We detected a relationship between a decreased healthy neuronal density of the habenula and depressive symptomatology in rats with OBX. We suggest that olfaction disorders might cause neuropsychiatric disorders by affecting neuronal degeneration in habenular nuclei.

Sex hormone alterations and systemic inflammation in chronic obstructive pulmonary disease

OBJECTIVE

Decreased anabolic hormone levels are described in chronic obstructive pulmonary disease (COPD), leading to important clinical consequences. The aim of this study was to evaluate the alterations in sex hormone levels in men with COPD to compare with age-matched control subjects, the determinants of these alterations, the relationship between hypogonadism and markers of systemic inflammation [interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-alpha)] and the androgen status during an acute exacerbation of COPD.

METHODS

A total of 103 COPD patients and 30 control subjects were admitted to the study. 83 stable COPD patients and 30 control subjects were evaluated as outpatients. 20 patients with COPD exacerbation were hospitalised and evaluated before discharge and after 1 month.

RESULTS

Testosterone and dehydroepiandrosteronesulphate (DHEAS) levels of both COPD groups were lower than that of the control group. Luteinizing hormone (LH), follicle stimulating hormone (FSH) levels were increased during exacerbation. Testosterone and DHEAS levels increased and LH decreased in follow-up measurements of COPD exacerbation group. Testosterone and DHEAS levels were lower in severe COPD [forced expiratory volume in 1 s (FEV(1)) < 50%], in patients with severe hypoxaemia (PaO(2) < 60 mmHg) and in hypercapnic patients. Circulating IL-6 and TNF-alpha concentrations were higher in both stable and exacerbation phase COPD groups than controls. There was no correlation between sex hormones and TNF-alpha or IL-6.

CONCLUSION

The alterations in sex hormone levels in COPD are particularly related to FEV(1), hypoxaemia and hypercapnia. There are significant differences in hormone levels during stable and exacerbation phases of COPD; the hormonal changes are marked during exacerbation and partially regress after 1 month when the disease is stabilised.

Congenital Cutis laxa associated with growth retardation

Congenital cutis laxa is a rare, clinically and genetically heterogeneous group of inherited disorders. It is characterized by degenerative changes in elastic fibres and manifests with skin laxity. Here we presented a six-month old boy with congenital cutis laxa associated with growth retardation. We reveal ultrastructural findings and discussed the differential diagnosis.

Subtrochanteric derotation osteotomy using a bent dynamic compression plate in children with medial femoral torsion

Subtrochanteric osteotomy of the femur using a bent dynamic compression plate is a simple, safe, and stable technique for correction of severe medial femoral torsion.

Neu?Laxova syndrome: a case report and review of the literature

Neu-Laxova syndrome (NLS) is a rare autosomal recessive syndrome, characterized by severe intrauterine growth retardation (IUGR), microcephaly, abnormal brain development, oedema and ichthyosis. It was first reported in 1971 by Neu et al. (Pediatrics 47: 610-612) and since then no more than 60 cases have been reported. A newborn girl delivered from a 29-year-old healthy mother was admitted to hospital with a thick membrane covering her body and dismorphic appearance. The diagnosis of NLS was made according to characteristic features. The syndrome is known to have a poor prognosis and the baby lived for 9 weeks. This case is one of the longest living cases of NLS and the fourth case reported from Turkey.

Use of Adhesives in Cleft Palate Surgery:A New Flap Fixation Technique

N-Butyl-2-cyanoacrylate (NB2C) is a synthetic tissue adhesive, and it has been used in many surgical procedures. This study was aimed at evaluating its efficacy in cleft palate repairs. Fifteen patients with soft palate and hard palate clefts had clefts repaired with the use of this synthetic adhesive. The ages at repair ranged from 11 months to 17 years, with an average of 2.4 years. Follow-up time ranged from 14 months to 24 months. No complications were found. The advantages of using NB2C were shorter operative time, more pushback gained, better hemostasis, early and well-tolerated feeding, tension-free closure, and better patient comfort. This study shows NB2C as a useful adjunctive material for affixing the mucoperiosteal flaps to the hard palate.

Combined intraoral and nasal approach to Tessier No:0 cleft with bifid nose

The surgical correction of craniofacial clefts is an extremely difficult field in pediatric plastic surgery. Facial clefts are rare entities that most plastic surgeons will rarely have to manage. Various surgical techniques devised by some authors for facial clefts have not still widely accepted. The bifid nose deformity is generally an indicator of Tessier No:0 clefts, with various degrees of skeletal problems. The nasal roof area is an important key point in determining the appropriate surgical technique for reconstruction. In this report, a case of Tessier No:0 with a moderate nasal bifidity and ours novel surgical repair technique combining oral and nasal incision are presented.

Blastic natural killer cell leukaemia with skin involvement: a case report

Natural killer cell leukaemia is generally accompanied by extramedullary involvement. CD4+ natural killer cell leukaemia frequently manifests with cutaneous involvement. The disease pursues a very aggressive course with no long-term survivors reported. We present a patient with CD4+ natural killer cell leukaemia with skin, bone marrow and peripheral blood involvement who is still on remission at the end of 2 years.

Early results of a modified technique of cryosurgery

The objective of this study was to present a simple, convenient, and reliable technique for the application of liquid nitrogen and to evaluate the effectiveness of curettage and cryosurgery. Between 1992 and 2002, 24 patients who had benign aggressive and low-grade malignant bone tumors were treated by curettage and cryosurgery. While cryosurgery was applied by the "direct pour" technique in the first seven patients, it was applied by the "pressurized spraying" technique in the others. Functional results were graded according to Enneking. The mean follow-up was 47 (range 9-131) months. There were no local recurrences. Three patients who underwent the direct pour technique developed partial skin necrosis. The functional results were excellent in 14 patients, good in six, and fair in four. When compared with previous reports on cryosurgery and its application techniques, we detected no tumor recurrence or complications, including soft-tissue injury, infection, and late fracture with liquid nitrogen applied by the pressurized spraying technique.

Effect of submaximal and incremental upper extremity exercise on platelet function and the role of blood shear stress

INTRODUCTION

Platelets are involved in the pathogenesis of atherosclerosis. Although physical exercise is recommended to prevent atherosclerosis, the effect of exercise on platelet function and the underlying mechanisms of these effects are not completely understood. Accordingly, we aimed to examine the effect of different intensities acute arm exercises on platelet function. In addition, we evaluated the effect of lipid peroxidation and fluid shear rate on platelet response.

MATERIALS AND METHODS

Twenty four healthy sedentary male volunteers aged 18-24 years performed submaximal and incremental exercises by upper extremity ergometer. The shear rate in the right artery was measured by Power Doppler Ultrasound (US) at rest and immediately after exercise. Pre and postexercise maximum intensities of ADP and collagen-induced platelet aggregation were measured using the impedance technique. Bioluminescent detection of thrombin-induced platelet ATP release and measurement of thromboxane B(2) (TxB(2)) levels (as a marker of thromboxane A(2) (TxA(2)) formation) by enzyme-linked immunoassay were performed before and after exercise.

RESULTS AND CONCLUSION

Shear rate increased after both submaximal and incremental exercise. Collagen-induced platelet aggregation increased after submaximal exercise, while ADP-induced aggregation and thromboxane B(2) levels did not alter with this protocol. Incremental exercise caused increased collagen and ADP-induced platelet aggregation and thromboxane B(2) levels. Neither of the protocols altered platelet ATP release. It was shown that acute upper extremity exercise increased platelet aggregation, without an increase in platelet release. Collagen-induced signalling pathways were more sensitive than those induced by ADP. The increase in thromboxane B(2) after incremental exercise implied increase in thromboxane A(2) formation and lipid peroxidation. Despite a significant correlation between platelet aggregation and thromboxane B(2) levels at rest, we found no clear-cut relationship between thromboxane A(2) formation, blood shear rate and platelet response to exercise.

Effect of hormone replacement therapy on ocular hemodynamics in postmenopausal women

PURPOSE

To evaluate the effect of hormone replacement therapy on ocular hemodynamics in postmenopausal women.

METHODS

Ocular Doppler ultrasonography was performed in 20 postmenopausal women on hormone replacement therapy (HRT) and in 20 women without treatment, as the control group. Central retinal artery (CRA), posterior ciliary artery (PCA) and ophthalmic artery (OA) flow velocities and vascular resistances were measured prospectively by a radiologist blinded to the therapy. There were no associated systemic or ocular diseases or any medication history.

RESULTS

The mean age of the patients on HRT was 50.05 +/- 4.5 yrs (range 44-62). The mean age of the control group was 52.8 +/- 4.09 yrs (range 46-65). The mean duration of HRT was 1.6 +/- 1.4 yrs (range 3 months - 5 years). There were no differences between the groups in terms of flow velocities, vascular resistivities or pulsatility indices of OA, CRA and PCA (p>0.05).

CONCLUSIONS

HRT is essential in postmenopausal women for relief of vasomotor symptoms, cardioprotection and prevention of osteoporosis. Even though vaso-occlusive complications of hormone preparations have been reported, we did not observe any changes in ocular hemodynamics detectable with Doppler ultrasonography.

Renal Doppler ultrasonographic findings in earthquake victims with crush injury

OBJECTIVE

In the Marmara earthquake, which occurred on August 17, 1999, 639 people had renal complications, and 477 needed hemodialysis treatment because of acute renal failure due to crush injury. Our objective was to use Doppler ultrasonography as a noninvasive procedure to provide renal hemodynamic information.

METHODS

We evaluated 9 patients with severe crush injury by using Doppler ultrasonography to measure renal resistive indexes within 16 to 32 hours after the earthquake and 6 weeks later. All patients had acute renal failure and underwent hemodialysis.

RESULTS

All measured initial resistive indexes were high (mean +/- SD, 0.83 +/- 0.08), and they were correlated with the number of hemodialysis sessions (r = 0.703; P = .034), the duration of hemodialysis treatment (r = 0.819; P = .007), and oligoanuria (r = 0.937; P < .0001). All patients recovered from the acute renal failure, and repeated Doppler ultrasonography showed significant decreases in resistive indexes (0.59 +/- 0.07; P < .01) and renal lengths (P < .05).

CONCLUSIONS

In crush injury, measurement of renal resistive indexes can be useful for the prognosis of recovery from acute renal failure.

Correlation between clinical stages and EEG findings of subacute sclerosing panencephalitis

In this retrospective study 67 patients with SSPE seen between the years 1980 and 1998 were reviewed. Using the criteria of SSPE diagnosis (clinical signs, characteristic EEG patterns, high titres of measles antibodies in the serum and CSF), the patients were divided into two groups. Group A fulfilled all criteria, however, due to the inability of measuring measles antibody before 1987, it was not possible to observe the third criterion in Group B. Among 67 patients, groups A and B consisted of 51 boys and 16 girls ranging in age between 1 to 23 years, mean age 13.1. The male/female ratio was 3.1. The periodic EEG complexes (PCs) were usually bilateral, synchronous and symmetrical. PC amplitude asymmetry was seen in 12 patients and 2 patients had no PC synchronization between the hemispheres. Six patients had more than one form of PC. Delta activity in anterior hemispheres after PC was seen in 40 patients, mostly in stage 2A. Thirty-two patients had focal epileptiform abnormalities in multiple locations at every stage but most frequently in frontal, central and temporal regions. One patient had PC over both hemispheres and periodic lateralized epileptiform discharges (PLEDs) over the right hemisphere. The EEG findings described and observed in our study do not seem to be specific to SSPE but these findings were not atypical or unusual.

Malignant fibrous histiocytoma developing in a burn scar

Malignant fibrous histiocytoma (MFH) which is usually originated from muscles and deep fascia and rarely from the subcutaneous tissue is the most common soft tissue sarcoma; and it frequently invades the extremities. Occurrence of this tumor on a burn scar of scalp is a very rare entity. In the literature, there were only four reported malign fibrous histiocytoma cases that originated from a burn scar but none of them was at the scalp region. A female patient complaining about a painful mass at the scalp region was admitted to our clinic twenty years after burning with hot water when she was 3 years old. Pathological and clinical features of this rapidly growing malignant fibrous histiocytoma were similar with the other cases reported before. After the diagnosis was clear as a pleomorphic storiform type of MFH, a wide tumor excision was done because of the high risk of local recurrence.

Geometric limit of multiple local Limberg flaps: a flap design

The Limberg rhombic flap is a reliable and widely used technique in head and neck surgery. Since Limberg introduced his original design in 1946, several modifications of the technique have been described. Although a single Limberg flap is frequently used at the face to close small to medium defects, multi-Limberg flap techniques can help the surgeon to cover moderate to large defects of the extremities, trunk, and back. In this study, a design of four neighboring local Limberg flaps to cover a moderate to large defect without using a skin graft is introduced. It is believed that this design is the geometric limit of multiple Limberg flaps that can entirely cover a single large rhombic defect, because one Limberg flap unit can only be adjoined by three others, one from the tip and two from the sides. This flap design of four local Limberg flaps is also the only geometrically possible design that can keep all the bases of these four flaps free of incisions if one attempts to prepare four small Limberg flaps around a large rhombic defect.

Effect of color Doppler system on the twinkling sign associated with urinary tract calculi

PURPOSE

The aim of this study was to assess the effect of the color Doppler system on the artifact known as the "twinkling sign."

METHODS

Sixty-five patients with at least 1 urinary tract calculus seen on sonography were examined with color Doppler sonography. Two color Doppler systems of 2 different generations were used. Examinations included gray-scale, color Doppler, power Doppler, and spectral evaluations of the calculus with various settings of Doppler gain, velocity range, color filter, focal depth, and acoustic power.

RESULTS

A color artifact was present within and/or distal to 29 (39%) of 75 urinary tract calculi when the old generation system was used. Use of the new generation system produced this color artifact within and/or distal to 72 (96%) of the urinary tract calculi. The intensity of the artifact was affected by the acoustic output of the equipment.

CONCLUSIONS

The twinkling sign is an artifact that can not only lead to misdiagnosis of vascular flow within a structure but also help differentiate a very small stone from other small echogenic structures when later generation "all-digital" systems are used. The color sensitivity of the system and acoustic power used are important technical factors that affect the production of this artifact.

Treatment of a neck burn contracture with a super-thin occipito-cervico-dorsal flap: a case report

Postburn neck contractures still represent a surgical challenge due to their exposed location; and early operative treatment is necessary for both functional as well as aesthetic reasons. An excellent functional result was obtained by using a supercharged super-thin occipito-cervico-dorsal flap described by Hyakusoku to repair a large defect of the anterior neck following a very wide neck burn contracture release. In this case report, the technique and its advantages among the other reconstructive modalities are discussed briefly.

The effect of asphyxia on gut blood flow in term neonates

Transcutaneous Doppler ultrasound measurements were made of the superior mesenteric artery of 25 term infants to correlate the intestinal blood flow with neonatal acid-base status as measured in umbilical artery blood and newborn condition as reflected by Apgar score. Compared with the babies whose umbilical artery pH was higher than 7.20 (peak systolic velocity: 84.1 cn/sn, mean velocity 48.6 cm/sn), the blood flow of superior mesenteric artery was significantly decreased in the newborn babies whose umbilical artery pH was less than 7.20 (peak systolic velocity 48.8 cm/sn, mean velocity = 32.6 cm/sn). Although no such relationship existed between Apgar scores and superior mesenteric artery blood flow indices, a significant linear correlation between superior mesenteric artery blood flow and umbilical artery pH was noted. A reduction of intestinal circulation was observed during umbilical cord blood acidemia and hypoxemia.

Color Doppler imaging in the diagnosis of the acute scrotum

OBJECTIVES

To determine the value of color Doppler imaging (CDI) in the diagnosis of acute scrotum.

MATERIALS AND METHODS

We evaluated 102 consecutive patients referred to our institution with scrotal pain. All patients were evaluated by physical examination, ultrasound with stethoscopic Doppler followed by CDI. Radionuclide scanning was performed only in 14 patients. Patients with a diagnosis of testicular torsion by CDI underwent surgical exploration. Patients with CDI diagnosis of epididymorchitis were treated with intravenous antibodies and underwent repeat CDI evaluation after treatment.

RESULTS

Of the 102 patients evaluated ages 11-44, CDI diagnosed 18 patients with testicular torsion and 78 patients with epididymorchitis. Cases of testicular torsion were found to have absent flow on CDI. CDI findings of normal or increased flow were present in all patients with epididymorchitis. All cases of torsion were confirmed on surgical exploration, 11 patients underwent orchidopexy and 7 patients underwent orchiectomy. No cases of testicular atrophy were encountered on long-term follow-up in patients with epididymorchitis. Diagnoses in the remaining patients were testicular tumor 1, testicular abscess 2, scrotal hematoma 2 and incarcerated hernia 1. CDI was found to be 100% sensitive and 100% specific in the diagnosis of the acute scrotum.

CONCLUSION

We found CDI to be more accurate and reliable than physical examination in conjunction with gray-scale ultrasound and Doppler stethoscopic examination in the differential diagnosis of the acute scrotum. CDI is practical and can be performed in a rapid manner. CDI should become an integral part of the urologist's armamentarium in the differential diagnosis of the acute scrotum.

Mammography in men with breast cancer: review of the mammographic findings in five cases

Male breast carcinoma is an uncommon malignancy. The age at diagnosis and tumour stage are more advanced in males than in females. Poor alertness of both men and physicians for this infrequent disease may account for the delay in diagnosis. In this study, we reviewed male breast carcinomas seen within a 3 year period and assessed the mammographic findings. There is limited experience in the diagnosis of breast carcinoma in male patients and this has been considerably influenced by the knowledge of female breast cancer. The diagnostic criteria for the female counterpart cannot always be safely applied to male breast cancer. Mammograms of men with breast cancer usually show an uncalcified subareolar mass, which may mimic or be obscured by gynaecomastia. Occasionally, punctate calcifications may indicate malignant disease in the male breast. Early detection of male breast cancer may prolong the survival rate as in cases of female breast cancer.

Intrarenal varices in portal hypertension: demonstration by color Doppler imaging

The gray-scale ultrasonographic appearances of dilated intrarenal vascular structures may mimic peripelvic cysts or hydronephrosis. We report a patient with portal hypertension in whom color Doppler ultrasound was found to be a very practical imaging technique in demonstrating varices of the renal segmental veins.

The measurements of some anthropometric landmarks of the mandible; a preliminary anatomical study

In this study, the morphometric measurements were done on human cadaver mandibles including ramus height and width, angle between ramus and corpus, the relation between foramen mentale and teeth. The aim of this study was to establish some standards with the achieved results in order to expand these studies in some reconstructive surgical areas. As a result, the standard measurements were established under the heads of short and long ramus, acute and obtuse angle mandibles.

Comparison of four different types of osteotomes for lateral osteotomy: a cadaver study

In this study, four different types of osteotomes were compared in lateral osteotomy of cosmetic rhinoplasty. For this purpose, 32 halves of 16 cadavers were used. Fracture line and mucosal injuries were evaluated. Statistical analyses were made to find out if there is any relation between the type of osteotomes and the extent of injury. At the same time bone thickness was measured on the osteotomy line. Wide osteotomes have shown more mucosal injuries which is statistically significant. Bone thickness does not exceed 3 mm at any point on the osteotomy lines.

Testicular microlithiasis associated with seminoma: Gray-scale and color Doppler ultrasound findings

Testicular microlithiasis associated with seminoma was found in a 32-year-old infertile man. Gray-scale and color Doppler ultrasound findings are discussed and a brief review of the literature is presented.

The diagnostic value of colour Doppler ultrasound in central venous catheter related thrombosis

AIM

This prospective study was performed to establish the correlation between colour Doppler ultrasound (US) observations and venography in detecting catheter-related thrombosis.

METHOD

Forty-four patients with subclavian venous catheters were studied. The sensitivity and specificity of colour Doppler US was determined for the diagnosis of central venous thrombosis and compared with contrast venography. Criteria considered to show the presence of catheter-related thrombosis included visualization of thrombus (T), absence of spontaneous flow (S), absence of phasicity of flow with respiration (P), incompressibility of the vein with probe pressure (C) and visualization of increased venous collaterals (V).

RESULTS

Analysing each variable separately, P had the highest sensitivity (94%) and S had the highest specificity (100%). The best combinations for diagnosis were T+P, P+S, and T+P+S with a sensitivity of 94% and specificity of 88%. Overall diagnostic value of colour Doppler US had a sensitivity of 94% and specificity of 96%.

CONCLUSION

Colour Doppler US is a reliable method for detecting central venous catheter-related thrombosis, especially if several parameters are evaluated in combination.

[Reconstruction of the distal lower extremity defects with distal pedicled fasciocutaneous flaps]

Soft-tissue coverage of defects in the distal lower extremity has its limitations because of minimal blood supply to the skin and the thin muscle layer. Split-thickness skin grafting is impossible in cases of defects of tendons or bones. Local flaps are applicable only for smaller defects. With the cross-leg flaps, it is necessary to immobilize the patient for a long time. Special microsurgical technique and knowledge are needed for the free flaps. Fasciocutaneous flaps of the lower extremity after Donski and Fodgestam are simpler and safer than the other methods. From 1987 to 1992, this method was successfully used on 15 patients in the Department of Plastic Surgery of Sişli Etfal Hospital in Istanbul. In the two-thirds of those patients, accidents were the cause of the defects. The advantages of this methods are: simpler technique, larger flap-surface, earlier mobilisation of patients, better adaptation of the flap to its neighbourhood regarding colour and thickness.

Wandering accessory spleen

A patient with an excessively mobile accessory spleen detected on ultrasound examination is reported in whom a normally located spleen was also found. Sonographic and colour Doppler imaging criteria were used for making the specific diagnosis. The large accessory spleen has been demonstrated at different sites within the abdomen on subsequent follow-up sonographic examinations. The splanchnic flow pattern obtained from the long vascular pedicle of the accessory spleen indicated normal perfusion. Since the perfusion of the wandering accessory spleen was not compromised by torsion, and the patient refused surgical intervention, a conservative approach was considered to be appropriate.

Investigation of seasonal variations in cow serum retinol and beta-carotene by high performance liquid chromatographic method

1. High performance liquid chromatography (HPLC) was used to determine beta-carotene and retinol in cow serum. 2. Two groups of state and private farm cows (Groups 1 and 2) were used to assess seasonal variation when different food sources were fed to cows on serum beta-carotene and retinol concentrations. 3. Mean serum concentrations of beta-carotene and retinol from October to April in both Groups 1 and 2 cows were lower (P less than 0.05) than in the other months when the cows were fed various combination of maize silage, alfalfa and carrot residues and grass hay, respectively. 4. Mean serum beta-carotene and retinol concentrations in June and July were higher (P less than 0.05) than in other months when the cows were in pasture. 5. Mean serum beta-carotene and retinol concentrations in May, August and September were lower (P less than 0.05) than in June and July and higher (P less than 0.05) than in other months when a lesser amount of green pasture was available to the cows. 6. There was a seasonal variation (P less than 0.05) in serum beta-carotene and retinol concentrations. When the carotene intake is very high, conversion of beta-carotene to retinol decreases. Mean monthly serum beta-carotene and retinol concentrations showed that combination of alfalfa hay and maize silage, and grass hay and carrot residues can maintain adequate serum beta-carotene and retinol concentrations during the dry season.