Dogan Selcuk

An unusual case of biliary obstruction caused by Dicrocoelium dentriticum.

Dicrocoelium dentriticum (D. dentriticum) is a liver fluke induced biliary obstruction. Infection usually occurs in herbivores such as sheep, goats and deer; human infection is very rarely encountered in clinical practice. We report on a 65-y-old female presenting with biliary obstruction caused by D. dentriticum. Following treatment with triclobendazole, her symptoms disappeared, and laboratory values returned to normal range within 6 months. Parasitosis is an important cause of biliary obstruction. We suggest that for patients presenting with biliary obstruction, D. dentriticum should be included in the differential diagnosis.

Acute renal failure in a patient with severe hemolysis.

Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal disorder of bone marrow. It is characterized by blood cells lacking membrane proteins that are normally attached by the glycosylphosphatidylinositol (GPI) anchor. The cellular defect arises in a hematopoetic stem cell and is due to somatic mutation of the Phosphatidylinositol-glycan protein-A gene (PIG-A gene), encoding a protein needed for the biosynthesis of the anchor GPI. Paroxysmal nocturnal hemoglobinuria is presented by intravascular hemolysis, cytopenias, frequent infections, bone marrow hypoplasia, and a high incidence of life threatening venous thrombosis. Kidney involvement is usually benign and secondary to chronic tubular deposition of hemosiderin. Acute renal failure may occur in association with a hemolytic crisis. Here we report a case of 40-year-old woman with hematuria, pancytopenia, and acute renal failure due to PNH.

Endovascular Treatment of Persistent Epistaxis due to Pseudoaneurysm Formation of the Ophthalmic Artery Secondary to Nasogastric Tube

We present the case of a 60-year-old man with persistent epistaxis for 20 days that had started 2 weeks after removal of a nasogastric tube placed for an abdominal operation. There was no pathologic finding at selective facial and internal maxillary artery injections. An injury to the ethmoidal branches of the ophthalmic arteries or other arterial origins of bleeding was suspected. The internal carotid artery angiography revealed a pseudoaneurysm of an anterior ethmoidal branch of the left ophthalmic artery. The pseudoaneurysm was occluded with NBCA-histoacryl (25%) injection.

Endovascular treatment of a congenital dural caroticocavernous fistula

Carotico-cavernous sinus fistula is a rare anomaly in infancy. We report a 3-month-old boy with progressive symptoms and threatened visual loss requiring urgent therapeutic intervention. Embolization using n-butyl 2-cyanoacrylate was performed with immediate and dramatic results.

Partially thrombosed fusiform inferior thyroid artery true aneurysm mimicking a thyroid nodule.

Aneurysms of the inferior and superior thyroid arteries are extremely rare. They might be related to atherosclerosis or might occur secondary to trauma or interventional procedures. 1-5 Unruptured aneurysms may present with swelling of the neck, dysphagia, and hoarseness due to recurrent laryngeal nerve compression. 1 Ruptured aneurysms, conversely, may present with mediastinal hemorrhage and hypovolemic shock. 1 Diagnosis of inferior and superior thyroid artery aneurysms are usually made by computed tomographic or angiographic studies or both. Color Doppler sonography may also depict this vascular condition. 2 We report a case with a partially thrombosed true fusiform aneurysm of the inferior thyroid artery (ITA). The unique feature mimicking a thyroid nodule on sonography is presented.

Orchiopexy: a cause of benign testicular lobulation.

esticular cancer accounts for only 1% of all malignancies in men, and it is more common in black men.1 Patients with cryptorchidism are 2.5 to 8 times more likely to have testicular cancer.2 Testicular cancer commonly presents as a painless mass or vague discomfort in the scrotum. It is essential to obtain the patient’s medical history to narrow the possible diagnoses. The principal role of sonography in the diagnosis of testicular cancer is to help distinguish intratesticular from extratesticular lesions because most extratesticular masses are benign, and intratesticular masses are more likely to be malignant.3,4 Here we report a case of a patient who had previously undergone orchiopexy in which sonographic examination revealed testicular atrophy and lobulation. To our knowledge, this is the first case report that describes orchiopexy as a cause of testicular lobulation.