Effect of pretreatment and membrane orientation on fluxes for concentration of whey with high foulants by using NH3/CO2 in forward osmosis

Usage of forward osmosis membrane in FO mode, in which active and support layers of the membrane were in contact with the feed and the draw solutions respectively, provided higher initial water flux (12L/m²h) than the usage of membrane in PRO mode (6L/m²h) having opposite orientation but fluxes approached to each other after 4h during concentration of whey with NH₃/CO₂ as draw salt. High organic and inorganic foulants of whey was considered as reason for observed result in addition to lower solute resistivity. Initial water flux (8,5L/m²h) was lower when pre-treatment was applied before forward osmosis process but final flux (4L/m²h) was equal flux of non pre-treatment. Reduction of solute resistivity or absence of hydraulic pressure can be reasons for lower initial flux. Detection of organic carbon but absence of lactose in draw solution showed passage of molecules being different than lactose into draw solution.

Surgical Management of Pulmonary Aspergilloma

Records of 59 patients (41 males and 18 females) who underwent 70 operations for pulmonary aspergilloma in a 23-year period were examined retrospectively. Sixty-three operations were for primary treatment of pulmonary aspergilloma, and 7 were for complications of surgery. Twenty-six postoperative complications occurred in 19 patients. Three lobectomies that resulted in bronchopleural fistula were managed by intercostal muscle-flap closure and partial thoracomyoplasty. Two patients died within the first week of surgery. Surgery is the treatment of choice for most patients with pulmonary aspergilloma. Selective bronchial artery embolization is helpful only in combating hemoptysis, and this has been considered a temporary measure in most reports. Thus, open thoracotomy and anatomical resection are recommended as early as possible after the diagnosis is established.

Effect of locally applied transforming growth factor Beta3 on wound healing and stenosis development in tracheal surgery

BACKGROUND

Tracheal stenosis constitutes one of the most frequently seen problems in thoracic surgery. Although many treatment modalities to prevent fibroblast proliferation, angiogenesis, or inflammation that causes tracheal stenosis have been attempted, an effective method has not yet been found. In this study, a transforming growth factor beta3 (TGF-β3)/chitosan combination was used for this purpose.

METHODS

A slow-release preparation containing a thin layer of TGF-β3 with a chitosan base was made. Thirty albino Wistar rats were divided into 3 groups. A full-layer vertical incision was made in the anterior side of the trachea of each rat between the second and fifth tracheal rings. The tracheal incision was sutured. Group A was evaluated as the control group. In Group B, a chitosan-based film was placed on the incision line. In Group C, a slow-release TGF-β3/chitosan-coated substance was placed on the incision line. The rats were killed on day 30, and their tracheas were excised by cutting between the lower edge of the thyroid cartilage and the upper edge of the sixth tracheal ring together with the esophagus. Epithelialization, fibroblast proliferation, angiogenesis, inflammation, and collagen levels were evaluated histopathologically by the same histopathologist.

RESULTS

Statistically significant differences were not found among the 3 groups. Cold abscesses were observed at the incision sites in both the TGF-β/chitosan and chitosan groups. These were thought to have formed due to the chitosan.

CONCLUSIONS

As this was the first experiment in the literature to use this type of TGF-β3 formulation, we intend to change the formulation and perform this study again with a different TGF-β3/chitosan preparation.

False positive PET scan deserves attention

PURPOSE

Pulmonary focal lesions are frequently identified incidentally. Furthermore, a final diagnosis is really a considerable problem for patients having risk factors for malignancy or particularly for a newly detected nodule during the postoperative period after any kind of lung surgery. For treatment decisions, the nature of the lesions needs to be clarified. Relatively recently positron emission tomography (PET) scan has been introduced as a non-invasive imaging method for the diagnosis of lesions on the basis of metabolic activity.

METHODS

In this study 19 cases with false-positive nodules on PET scan are presented. Chest x-rays and thoracic computed tomographies (CT) were performed to all patients. Due to abnormal/suspicious lesions on radiologic imagies, PET scan was performed to these patients and high standard uptake values (SUV) above the cut-off value of 2.5 were suggestive of malignancy. Invasive procedures were performed to the patients with high suspicion of malignancy.

RESULTS

Histology of the resected lesions showed that all of them were benign and therefore the PET results were false-positive. The final diagnoses were tuberculosis, aspergilloma, bronchiolitis obliterans organizing pneumonia (BOOP), sarcoidosis, sequestration, anthracosis and hamartoma.

CONCLUSION

Patients living especially in countries with a high incidence of granulomatous diseases like tuberculosis, or patients in postoperative periods with high SUV should be studied thoroughly for false-positive PET results.

Primary synovial sarcoma of lung

Synovial sarcoma (SS) is a highly malignant tumor that accounts for 10% of all soft-tissue sarcomas. Primary SS arising from the lung is extremely rare, and the prognosis is poor. We report a case of pulmonary SS presenting with a mass lesion invading the right upper and middle lobes, extending to the mediastinum and the chest wall. After tru-cut biopsy, surgical resection was performed. The final diagnosis was SS (biphasic type) based on histological and immunohistochemical findings. There are no guidelines for optimal treatment due to the rarity of these tumors. Current treatment includes surgery and adjuvant chemotherapy and/or radiotherapy.

Value of autofluorescence in video-assisted thoracoscopic surgery in pleural diseases

BACKGROUND

Autofluorescence (AF) examination in thoracoscopy has not been used frequently. Here, our aim was to determine whether AF examination contributes additional information to white-light (WL) examination when attempting to detect malignant pleural lesions. We also liked to know whether the effectiveness of WL and AF-mode combination would be different for various pathologies or lesions of the pleura.

METHODS

It is a retrospective study. Thirty-three patients with unexplained exudative pleural effusions underwent AF-assisted video-assisted thoracic surgery (VATS). Patients' data from the files were evaluated. In each case, the pleural cavity was thoroughly examined under WL alone and then in AF mode.

RESULTS

The sensitivity and specificity of AF-assisted VATS for detecting malignant pleural lesions were 78.7 and 85%, respectively, and there were 21.3% false negatives. In the group with metastatic pleural disease, AF VATS correctly identified all lesions as AF positive, whereas sensitivity was lower for the group with malignant mesothelioma. Seven lesions, which were not diagnosed under WL, were detected in AF mode.

CONCLUSION

The overall sensitivity of AF-assisted VATS for detecting pleural malignancies was not satisfactory because of diagnostic errors in malignant mesothelioma. But it would be useful in detecting small malignant pleural lesions, which are not diagnosed under WL.

Excision of ectopic mediastinal parathyroid adenoma via parasternal videomediastinoscopy

Mediastinum is one of the place in which ectopic parathyroid adenomas can be located.Here, an ectopic mediastinal parathyroid adenoma, which was excised via parasternal videomediastinoscopy was presented. The patient with chronic renal insufficiency had increased calcium levels persistence after the surgery for cervical parathyroid adenoma.Radiologic and scintigraphic examinations revealed a focal intense nodule in anterior mediastinum. Parasternal videomediastinoscopy was performed via parasternal incision through the second intercostal space. Ex-vivo specimen radioactivity measurements and frozen examination confirmed parathyroid adenoma. Calcium levels were decreased dramatically after the operation. Parasternal videomediastinoscopy could be an alternative surgical way in anterior mediastinal small masses such as ectopic parathyroid adenoma. It is the first case in which parasternal videomediastinoscopy was used for excision of mediastinal parathyroid adenoma.

A Low-Cost and Simple Method to Stop Intraoperative Leakage-Type Bleeding: Use of the Vancomycin–Oxidized Regenerated Cellulose (ORC) Sandwich

Intraoperative bleeding may cause life-threatening complications in patients if such bleeding cannot be brought under control. Various materials are available for stopping such bleeding. However, there are some difficulties in the acquisition and application of these materials. The aim of this study was to investigate the efficiency of the low-cost and simple-to-prepare vancomycin-oxidized regenerated cellulose (ORC) sandwich in surgical bleeding control. Thirty New Zealand rabbits were used for this purpose. The animals were separated into three groups as group 1 (n = 10), control group; group 2 (n = 10), oxidized regenerated cellulose (ORC) group; and group 3 (n = 10), vancomycin-ORC sandwich group. Left thoracotomies were performed on the rabbits under general anesthesia, and bleeding was created in the parietal pleura. The amount of bleeding in the groups was measured and compared. The amount of bleeding in the group in which the vancomycin-ORC sandwich was used was found to be less, compared to the other two groups. According to these results, we conclude that the vancomycin-ORC sandwich can be used safely in the control of intraoperative leakage-type bleeding, as the vancomycin-ORC sandwich is a low-cost, easily applied, and easily acquired material.

Response to rituximab and prednisolone for opsoclonus-myoclonus-ataxia syndrome in a child with ganglioneuroblastoma

Opsoclonus-myoclonus-ataxia (OMA) syndrome is a rare neurobehavioral paraneoplastic disorder in children with neuroblastic tumors. The neurologic symptoms are generally treated with a number of immunosupressive and immunomodulating agents. A 4-year-old previously healthy male patient was admitted to the authors' center with progressive ataxia, gait disturbance, difficulty of speech, and opsoclonus. He had a diagnosis of ganglionueroblastoma at the thoracal paraspinal region. Following surgery, the patient received IVIG and prednisolone but his cerebellar symptoms progressed. Rituximab therapy was started and continued for total 8 weeks without any side effect. The authors observed excellent neurologic response in the patient at the 4th week of treatment. Rituximab is a new, promising, and safe therapy for OMA syndrome in children with neuroblastoma.

Spontaneous rupture of a giant diaphragmatic hydatid cyst into the intrapleural space

OBJECTIVE

We report a case of giant diaphragmatic hydatid cyst which ruptured spontaneously into the intrapleural space in a patient with coexistent giant hepatic hydatid cyst.

CLINICAL PRESENTATION AND INTERVENTION

A 62-year-old female was admitted for dyspnea, nausea, vomiting, and right thoracic pain. Clinical findings, laboratory and radiological examinations including multislice computed tomography scan were consistent with the diagnosis of a giant diaphragmatic hydatid cyst which ruptured into the intrapleural space. Surgical intervention was performed through thoracotomy and phrenotomy in a one-stage operation for both cysts.

CONCLUSION

This case shows that hydatid cysts of the diaphragm can rupture into the intrapleural space spontaneously. One-stage operation through thoracotomy may be successful for the surgical intervention for diaphragmatic hydatid cysts with coexistent hepatic cyst.

Routine intraoperative aspiration of gallbladder during laparoscopic cholecystectomy

BACKGROUND

Technical modifications and methods for gallbladder dissection to minimize the risk of gallbladder perforation during laparoscopic cholecystectomy (LC) are described. The authors aimed to investigate the effects of gallbladder aspiration during LC on the operative and postoperative course of patients.

METHODS

For this study, 200 patients undergoing LC for symptomatic cholelithiasis were randomly divided into two groups. Gallbladders were aspirated before dissection in group A (n = 100), and they were not aspirated in group B (n = 100). Operative and postoperative data on the patients were collected.

RESULTS

The rate of gallbladder perforation was significantly lower in group A than in group B (p = 0.0003). The operative time was significantly shorter in group A (46.70 +/- 15.93 min) than in group B (60.75 +/- 22.09 min) (p = 0.047). Postoperative complications were more numerous in group B. The hospital stay was significantly longer in group B (1.55 +/- 0.81 days) than in group A (1.3 +/- 0.5 days; p = 0.004).

CONCLUSION

The findings demonstrate the advantages of gallbladder aspiration in elective cases.

Mycobacterial infection of intraparenchymal bronchogenic cysts

Bronchogenic cysts (BCs) may rarely cause some interesting and unusual complications. Although infection is a common complication of BCs, there are only two patients with BC infected with mycobacterium in English literature. Two intraparenchymal BCs infected with mycobacterium are presented here as unusual complications. Cystectomy was performed for the cysts. They were given antituberculosis treatment. No complication or recurrences were detected in follow up period.

Survival of biphasic pulmonary blastoma

Pulmonary blastoma is a rare malignant lung tumor with a poor prognosis. It is composed of immature mesenchymal and epithelial components that resemble fetal lung tissue. We aimed to share our treatment results in biphasic pulmonary blastoma. In Ataturk Chest Disease and Thoracic Surgery Center, five patients with biphasic pulmonary blastoma (four men, one woman, aged between 27 and 61-mean 39.4) were treated between 1987 and 2000 (0.3% of operated NSCC). Hemoptysis, cough, chest pain and dyspnea were the symptoms. Anemia and high erythrocyte sedimentation rate were determined in two patients. Radiological examinations revealed a mass in four patients and massive pleural effusion in one. None of the patients were diagnosed preoperatively and hence all patients underwent exploratory thoracotomy. Three lobectomy, one pneumonectomy and one wedge resection were performed. Histopathological examinations revealed biphasic pulmonary blastoma in all the patients. Pathological stagings were as follows: 1 patient in T1N0M0 and 1 patient in T2N0M0 (198 and 112 months survival, respectively), three patients in T2N1M0 (9,10,17 months survival). In follow up period, prostate carcinoma and rectum carcinoma were detected as second primary tumors in the patient in stage T2N0M0. In patients who have small size tumors without nodal involvement, long-term survival can be obtained with radical surgery; even in biphasic pulmonary blastomas. According to our limited experiences, N1 nodal involvement shows very poor prognosis.

The effects of estradiol and progesterone on the synthesis of collagen in tracheal surgery

OBJECTIVE

Estrogen and progesterone have the decreasing effect on massive collagen synthesis in wound healing. Here, it is aimed to determine their decreasing effect on collagen accumulation and fibroblast proliferation in trachea histologically and to understand if they would be protective for tracheal stenosis.

METHODS

Thirteen male Winstar rats were divided randomly into two groups: estrogen-progesterone group (group 1, eight rats) and control group (group 2, five rats). Under general anesthesia, tracheas were incised vertically extending from second to fifth tracheal ring. Incision was closed with absorbable sutures. Estrodiol benzoat and progesterone was given intramuscularly to estrogen progesterone group, saline solution to control group. After 4 weeks they were sacrificed and tracheas were excised. Horizontal cross section of the narrowest part of the incised trachea was examined histologically. Epithelial regeneration, inflammatory cell infiltration, angiogenesis, fibroblast proliferation and collagen deposition were evaluated by histological grading.

RESULTS

Statistically significant difference was found between the groups in collagen deposition and fibroblast proliferation (p=0.011, <0.05). For epithelial regeneration, inflammatory cell infiltration, and angiogenesis there was no difference.

CONCLUSION

As a result, it was proved that sex hormones inhibit massive collagen deposition and fibroblast proliferation in wound healing of tracheal surgery. Hence, they may prevent tracheal stenosis.

Chylopericardium mit Vena-subclavia-Thrombose

In dieser Kasuistik stellen wir einen Fall mit beidseitigem Chylothorax und Perikardtamponade aufgrund eines durch eine Thrombose der Vena subclavia verursachten Chylus vor, der als Ergebnis einer Phlegmone im Achselhöhlenbereich aufgetreten ist. Unseres Wissens wurden bisher bei keinem Fall solche kausalen Faktoren in der Literatur berichtet. Unser Fall wird mit wiederholter Thorakozentese und Anwendung von Perikard-Drainagen behandelt. Was immer die Ursache ist, die Perikardflüssigkeit muss bei einer Thrombose der linken Vena subclavia untersucht werden. Wird ein Chyloperikard bei seiner Entdeckung mit den geeigneten Methoden rechtzeitig behandelt, können die fatalen Komplikationen, die sonst entstehen könnten, verhindert werden.

Association between the metabolic syndrome and newly diagnosed coronary artery disease

This case-control study was designed to outline age- and gender-related differences of metabolic risk factors in a group of patients with coronary artery disease (CAD). Accordingly, a total of 366 consecutive patients with a recent diagnosis of CAD (139 women, 41-79 yr; 227 men, 39-78 yr) were screened between October 1999 and April 2001 at Baskent University Adana Medical Center, and 366 age- and gender-matched individuals were selected as a control group. We compared demographics, blood pressure, body mass index, waist circumference, lipid profile, fasting and post-prandial glucose-insulin levels between CAD patients and the control group. Prevalence of metabolic syndrome was 72.6% in females, and 39.0% in males with CAD. Hypertension, obesity and diabetes were more common in female patients; 64.5% of female patients had premature CAD and 83.5% of those had metabolic syndrome. In logistic (OR: 3.57 for women and OR: 1.59 for men) regression analysis, metabolic syndrome was independently associated with CAD in both genders. As a conclusion, prevalence of metabolic syndrome was significantly higher in patients with CAD than the control group, especially in female patients. The metabolic syndrome was independently associated with CAD in both genders.

A review of 24 patients with bronchial ruptures: is delay in diagnosis more common in children?

OBJECTIVE

Bronchial ruptures due to blunt chest traumas are rarely encountered injuries. Because they occur seldom in pediatric age groups, even total ruptures of bronchi can be overlooked in the absence of accompanying lesions. This condition may result in a delay of diagnosis that consequently leads to irreversible septic changes in the lungs, which make resections unavoidable. The determination of predisposing factor(s) may be valuable in predicting and prevention of such situations.

METHOD

We reviewed the records of 24 patients with bronchial ruptures hospitalized between January 1974 and December 2001 in Atatürk Center for chest disease and chest surgery. We divided the cases as 'early' and 'delayed' and each group consisted of 'adult (age>15 years)' and 'pediatric (age<15 years)' patients.

RESULTS

On reviewing the records of these patients, we observed that 75% of the delayed cases were under the age of 11 years when they survived the thoracic trauma.

CONCLUSION

The susceptibility of children to delays is emphasized and the possible causes are discussed in the light of world literature. Simple approaches to minimize the number of misdiagnosed pediatric cases are highlighted.

Chest injury due to blunt trauma

OBJECTIVE

Given its importance in trauma practice, we aimed to determine the pathologies associated with blunt chest injuries and to analyze the accurate identification of patients at high risk for major chest trauma.

METHODS

We reviewed our experience with 1490 patients with blunt chest injuries who were admitted over a 2-year period. Patients were divided into three groups based on the presence of rib fractures. The groups were evaluated to demonstrate the relationship between the number of rib fractures and associated injuries. The possible effects of age and Injury Severity Score (ISS) on mortality were analyzed.

RESULTS

Mean hospitalization time was 4.5 days. Mortality rate was 1% for the patients with blunt chest trauma, 4.7% in patients with more than two rib fractures and 17% for those with flail chest. There was significant association between the mortality rate and number of rib fractures, the patient's age and ISS. The rate of development of pneumothorax and/or hemothorax was 6.7% in patients with no rib fracture, 24.9% in patients with one or two rib fractures and 81.4% in patients with more than two rib fractures. The number of rib fractures was significantly related with the presence of hemothorax or pneumothorax.

CONCLUSION

Achieving better results in the treatment of patients with chest wall injury depend on a variety of factors. The risk of mortality was associated with the presence of more than two rib fractures, with patients over the age of 60 years and with an ISS greater than or equal to 16 in chest trauma. Those patients at high risk for morbidity and mortality and the suitable approach methods for them should be acknowledged.

Giant hydatid cysts of lung and liver

A 13-year-old girl was admitted to our clinic with the complaints of dyspnea, abdominal distention, cough, and right-sided chest pain.The diagnosis of disease was made with physical examination and radiologic evaluation. She underwent right thoracotomy and phrenotomy for the management of the hydatid cysts of the lung and the liver. The postoperative course was uneventful and she was discharged on the 10th postoperative day. We believe that the simultaneous management of concomitant pulmonary and hepatic hydatid cysts through a thoracicroute is a convenient option.

One-stage operation for hydatid disease of lung and liver: principles of treatment

OBJECTIVE

Hydatid disease is endemic in many countries throughout the world. Although we do not have exact figures, the disease is prevalent in Turkey. A considerable number of patients have additional liver cysts as well. In this study we reviewed our experience with hydatid disease of the lung and liver and discussed the principles of treatment.

METHODS

From 1971 to 1999, 2509 patients with pulmonary hydatidosis were referred to us, and 485 of them had concomitant liver cysts. Of these, 405 patients had cysts located on the dome of the liver, and they were operated on with phrenotomy through a right thoracotomy. Eighty patients who were found to have concomitant liver cysts in the lower part of the liver were referred to general surgery for a laparotomy.

RESULTS

Hydatid cysts located in the lungs were managed by means of cystotomy and capitonnage. For liver cysts, cystotomy and inversion of the cavity with sutures was the surgical method of choice, and a drain was left in place. In case of multiple cysts in the liver, needle aspiration was preferred. Twelve major complications, including excessive biliary drainage and bronchobiliary fistula, occurred in these patients.

CONCLUSIONS

We believe that management of pulmonary and hepatic cysts simultaneously through the thoracic route is convenient and should be encouraged in patients because this prevents a second operation. Needle aspiration can be applied only for liver cysts. It is absolutely contraindicated in lung hydatid cysts.

Combined primary repair of tetralogy of Fallot and aortic root replacement

Tetralogy of Fallot associated with ascending aortic aneurysm and aortic valve regurgitation is unusual. This combination necessitates a change in operative strategy during complete tetralogy repair. We present a 43-year-old woman who successfully underwent composite graft replacement of the ascending aorta and aortic valve during primary complete tetralogy repair. Histologic examination of the aorta revealed medial degeneration.

Analysis of atmospheric conditions during air pollution episodes in Ankara, Turkey

This paper presents a detailed analysis of the meteorological conditions that are associated with strong air pollution episodes in Ankara, Turkey. Based on climatological and air quality data [SO2 and TSP (total suspended particulates)] obtained for the winter months during 1989-1994, the analysis showed that the presence of weak atmospheric pressure gradients and warm air advection were the most important factors leading to high SO2 and TSP concentrations. In addition, the onset of the high air pollution episodes was generally associated with a trend toward negative vorticity at the 850-hPa level.

Relationship between bone mineral density and insulin resistance in polycystic ovary syndrome

The aim of the present study was to evaluate whether there is a relationship between bone mineral density (BMD) and insulin resistance and hyperinsulinemia in women with polycystic ovary syndrome (PCOS). The study consisted of 28 amenorrheic women with PCOS and 11 amenorrheic women without PCOS. Fifteen healthy women with normal ovulatory function, matched for age and body mass index (BMI), served as controls. BMD was measured at the lumbar spine and left femoral neck with dual-energy X-ray absorptiometry. Blood samples were obtained to measure serum levels of insulin, follicle-stimulating hormone, luteinizing hormone, sex hormone-binding globulin (SHBG), total and free testosterone, androstenedione and estradiol by radioimmunassay. Insulin resistance was estimated by the in sulin tolerance test (ITT), and K(ITT) was taken as the insulin sensitivity index. In the PCOS group, K(ITT) was significantly lower and insulin levels were higher than in either of the control groups (P < 0.001). BMD in the PCOS group was lower than in the healthy group and higher than in the amenorrheic control group (P < 0.05). In the PCOS group, there were positive correlations of BMD of the lumbar spine with insulin (r = 0.42: P < 0.05) and negative correlations of BMD with K(ITT) (r = -0.58; P < 0.001) and SHBG (r = -0.38; P < 0.05). The inverse association of BMD and K(ITT) was independent of BMI, insulin, SHBG, androstenedione, and free testosterone. In conclusion, insulin resistance and hyperinsulinemia in women with PCOS may be a relative protective factor against bone mineral loss.

Platelet aggregation size and volume in chronic obstructive pulmonary disease

In this study the effect of hypoxia on thrombocytes was investigated in patients with a chronic obstructive pulmonary disease (COPD). 15 Hypoxic (group 1), 15 nonhypoxic (group 2) patients with COPD and 10 healthy persons (group 3) were included in the study. The differences in haemoglobin, hematocrit and PaCO2 values of group 1 and group 2 were insignificant, but there was a significant difference between group 3 and the other two groups. The differences in blood pH values in the above groups were insignificant, but the differences in FEV1, FVC and PaO2 values were significant. We found that thrombocyte aggregation increased significantly in group 1 and group 2. Also the platelet count decreased and mean platelet volume increased significantly in group 1. As a result, we think that in hypoxic patients with COPD, thrombocyte count decreases, volume and aggregation formation increases and oxygen plus antiaggregation therapy may have positive effects on the survival and life quality of these patients.

Management of intrathoracic goitre

A retrospective review is presented of 20 cases with resection of intrathoracic goitre between 1975 and 1993. The mean age of the 11 men and nine women was 53 years. The intrathoracic goitre was primary in seven cases and secondary in 13. The presenting clinical features and the pathology, surgical risks and optimal approaches are discussed. Primary intrathoracic goitre should be approached via a thoracotomy, because of the independent vascular supply. As secondary intrathoracic goitres are supplied by vascular pedicles arising from the inferior thyroid artery, a cervical collar incision is preferable. In the event of significant mediastinal bleeding, which is difficult to control from a cervical incision, a T-shaped incision for partial or full sternotomy can be performed, or even thoracotomy.

Simultaneous bilateral fractures of the femoral neck and superior pubis ramus following renal failure-induced hypocalcaemic convulsions

There have only been a few reports of bilateral hip fractures resulting from hypocalcaemic convulsions. We report a case of simultaneous bilateral fractures of the femoral neck and superior pubic ramus caused by convulsions secondary to renal failure-induced hypocalcaemia. To our knowledge, such an occurrence has not previously been described.