Gunduz Ogut

Cephalic Vein and Hemodialysis Fistula Surgeon's Observation Versus Color Doppler Ultrasonographic Findings

The aim of this study was to evaluate whether preoperative color Doppler ultrasonography improves immediate success rates of arteriovenous fistulas for dialysis. One hundred twenty‐four patients with chronic renal failure underwent color Doppler ultrasonographic examination of both arms, including the cephalic vein, before arteriovenous fistula construction. Patients were randomly divided into 2 groups: A and B. In group A, there were 52 patients, and the surgeon planned to construct arteriovenous fistulas depending only on physical examination. In group B, which comprised 72 patients, surgeons performed arteriovenous fistula construction on sites labeled by color Doppler ultrasonography. In group A, of 52 patients who had surgery for arteriovenous fistula construction, 13 had fistulas that did not function. Among these 13 patients, 8 were found to have chronic thrombotic changes in the cephalic vein on color Doppler ultrasonography, and 5 had none of these changes. When we checked the color Doppler ultrasonographic findings, we noted that these 5 patients had decreased volume flow in the radial artery. On the whole, the arteriovenous fistulas worked in 39 patients (75%) and did not function in 13 patients (25%). In group B, surgeons followed the color Doppler ultrasonographic results. Of 72 patients who underwent the procedure, 68 patients (94.4%) had functioning fistulas, whereas 4 (5.6%) had fistulas that did not work. These 4 patients were found to have low volume flow in the radial artery. When both groups were compared by chi2 analysis, the difference was statistically significant (P = .002). Group B, in which patients were preoperatively evaluated by color Doppler ultrasonography, had a high success rate. We found that color Doppler ultrasonography is very helpful as a noninvasive procedure for this evaluation. Although many surgical clinics still perform arteriovenous fistula construction without the aid of color Doppler ultrasonographic findings, we think that the use of color Doppler ultrasonography should be emphasized before surgeons proceed with arteriovenous fistula construction.

Conventional enteroclysis with complementary MR enteroclysis: a combination of small bowel imaging

In recent years, there have been important improvements in different technologies and procedures to evaluate small bowel diseases. Among these new technologies and procedures: push enteroscopy, capsule endoscopy, magnetic resonance enteroclysis (MRE), and computed tomographic enteroclysis (CTE) have provided competitive and/or complementary modalities compared with classic conventional small bowel through and conventional enteroclysis (CE) examinations [1–10]. As very well appreciated, all modalities have their own advantages and disadvantages and indications and limitations. Despite these technologic advances, radiologic workup remains the first stage in the diagnosis of small bowel diseases and CE is the gold standard in the evaluation of mucosal pathologies, morphologic changes, and luminal and functional abnormalities [11]. However, in some cases, the effectiveness of CE decreases due to overlapping bowel loops. In addition, pathologic changes may not be limited to the small bowel wall. Although CE provides indirect findings concerning the wall and perienteric structures, complementary imaging is often needed in cases in which the pathologic changes go beyond the small bowel wall. Cross-sectional imaging methods such as computed tomography (CT) and magnetic resonance imaginig (MRI) are not affected by overlapping bowel loops, provide sufficient information about mural pathologies, and determine the extraluminal extension of the disease and surrounding structures. Multidetectorrow CT (MDCT) and MRI have become successful alternative cross-sectional imaging modalities for more detailed small bowel examinations [12–18]. MRI has multiplanar imaging capacity and excellent soft tissue contrast without any radiation exposure. In addition, with improved breath-hold, fast and ultrafast imaging sequences, high performance gradient coils, and dedicated abdominal phased array coils, image quality of gastrointestinal MRI has improved and the timing handicap has been overcome [15–22]. MDCT shares the same advantages as MRI but radiation poses well-known risks [10, 12–14, 18]. This report discusses the technique and findings of the combination of CE and MRE in the evaluation of different small bowel diseases.

Cavernous hemangioma of the kidney. Case report

Renal hemangiomas are rare neoplasms of the kidney, and the number of cases reported in the literature are about 200 since the original description by Virchow in 1867. Among these, only a few have been examined by the combination of ultrasound, computed tomography, and angiography. We present a demonstrative case diagnosed at our clinic and review the corresponding literature.

Carotid pulsatility indices in surgical menopause

A large body of literature is available concerning association of hormone replacement therapy (HRT) and postmenopausal women; to our knowledge, only few publications in purely surgical menopausal women. The aim of this study was to evaluate pulsatility indices (PI) of internal carotid arteries in two groups of surgical menopausal women who underwent HRT vs who did not. Measurements of the PIs of internal carotid arteries in both Groups were performed with color Doppler ultrasound. Measurements of the untreated group (n=38, mean age=47.10±2.45, group 1) were compared to those of treated group (n=42, mean age=47.35±2.37, group 2). A statistically significant increase in PIs of the carotid arteries were observed in Group 1 as compared to Group 2 in post-operative follow-up (p<0.001). Pre- and post-operative PIs in Group 1 measured at significantly different values pre- and post-operatively (right, 0.73±0.031 vs 0.80±0.049; left, 0.73±0.030 vs 0.80±0.052) (p<0.001). No such pre- and post-operative difference in PIs were noted among patients in Group 2 (right, 0.74±0.046 vs 0.73±0.044, p=0.200; left, 0.73±0.04 vs 0.73±0.04, p=0.504). When comparing both groups, no statistical difference was noted pre-operatively (right, p=0.501; left p=0.625); however, postoperative PIs did reveal a statistically significant difference (p<0.05). Pre- and post-operative side-to-side differences in the PIs of internal carotid arteries were not statistically significant (group1, 0.158 vs 0.211; group 2, 0.152 vs 0.356). In surgical menopausal women, the beneficial effects of HRT are in concordance with previous studies in terms of PI, which were performed with natural menopausal women.

Bone marrow changes adjacent to the sacroiliac joints after pelvic radiotherapy mimicking metastases on MRI

Abstract. Radiation-induced changes in the sacroiliac joints mimicking metastases on MR images were evaluated. Twelve patients who received radiotherapy to the pelvic region due to pelvic malignancy were included in the study. All patients had undergone external beam radiation therapy to the pelvic region, and 2 patients received supplementary internal radiation. The changes in the sacroiliac joints were evaluated. Computed-tomography-guided core bone biopsy from the bone marrow was taken from their corresponding MR sections in 5 of the patients. T1 hypointense and T2 hyperintense areas with ill-defined margins in the bone marrow adjacent to the sacroiliac joints were observed in all patients. On bone scintigraphy all the lesions demonstrated increased activity. Other radiological modalities excluded fracture, soft tissue mass, and osseous destruction. Bone biopsies demonstrated peritrabecular fibrosis and inflammatory cell infiltration. Patients receiving radiotherapy to the pelvis may demonstrate T1 hypointense/T2 hyperintense, ill-defined postradiotherapeutic benign changes in the sacroiliac joints. In the absence of any other signs of disease progression and when the imaging pattern is typical, close radiological follow-up should be sufficient to rule out metastases.

Abdominal leiomyosarcomas: radiologic appearances at various locations

Abstract. Leiomyosarcomas are soft tissue tumors that account for approximately 15% of all soft tissue sarcomas. Leiomyosarcomas may be located at almost any part of the abdomen but especially are more common in the retroperitoneum, followed by gastrointestinal tract and genital system. They develop mainly in adult life and are very rare in children. In this article, imaging findings of leiomyosarcomas in various abdominal locations are presented. Radiologic studies are capable of providing useful information on the localization, size, changes in the internal structure of the tumor, its extension and invasion. Leiomyosarcoma should be considered in the differential diagnosis in case of detection of a large, circumscribed, and heterogenous abdominal mass. Histopathologically, diagnosis of malignancy depends particularly on mitotic counts, size, rate of necrosis, and infiltrating margins.

The effect of an acute decrease in serum estrogen concentration on vessel walls: determination with color and pulsed Doppler ultrasound.

Abstract The aim of this study was to determine the effects of an acute decrease in serum estrogen concentration on endothelial function in women with surgically induced menopause through the use of color Doppler ultrasonography. There were 40 women scheduled to undergo total abdominal hysterectomy and bilateral salpingo-oopherectomy who participated in the study; 15 women not undergoing surgery also participated as a control group. Color Doppler ultrasonographic examinations of each surgical patient were obtained 3 days prior to and 7 days after surgery. Baseline measurements of the brachial arteries, including peak systolic velocity, end-diastolic velocity, true mean velocity, arterial diameter, and volume flow, were obtained for each patient. After baseline measurements were established, hyperemia was induced by inflating a blood pressure cuff on each patient’s upper arm to suprasystolic pressures for 5 min. To evaluate endothelium-dependent vasodilation, the ultrasonographic appearance of the brachial artery was evaluated after the cuff was deflated and removed from the arm. Measurements of peak systolic velocity, end-diastolic velocity, true mean velocity, arterial diameter, and volume flow were obtained, and were repeated at 1, 3, 5, 10, and 20 min subsequent to removal of the blood pressure cuff. The differences between baseline and maximum values of each Doppler parameter after the cuff deflation were calculated. No significant differences were identified in terms of laboratory findings or systolic and diastolic pressures in pre- and postoperative status of surgical patients, or between surgical patients and the control group. A significant difference in serum estradiol levels during pre- and postoperative periods (P<0.001) was detected. No significant difference in serum estradiol levels was detected among preoperative surgical patients and members of the control group (P=0.72). All net changes detected within each group during reactive hyperemia were statistically significant. No significant difference in values was detected among pre-, postoperative, and control subjects. Our study reveals that acute decrease in serum estrogen level does not appear to affect endothelial function; thus, we assume that this is mainly due to the result of postoperative surgical stress.

Enteroliths developed in a chronically obstructed afferent loop coexisting with gastric remnant carcinoma: Case report and review of the literature

A case of gastric remnant carcinoma coexisting with a chronic afferent loop syndrome harboring multiple enteroliths in a grossly dilated and elongated afferent loop is presented herein. The patient had undergone a Polya type antecolic Billroth II reconstruction for a stenosing duodenal ulcer 40 years previously. A concise review of the relevant literature is also 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.