Naime Tokmak

Hepatobiliary fascioliasis: imaging characteristics with a new finding.

PURPOSE The aim of this study was to present the imaging characteristics of patients with hepatobiliary fascioliasis and describe a new imaging finding. MATERIALS AND METHODS Imaging and clinical findings of five patients diagnosed with hepatobiliary fascioliasis were retrospectively evaluated. All patients were examined by abdominal ultrasonography (US) and computed tomography (CT); two were additionally evaluated by abdominal magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP). Diagnosis was confirmed by serology and parasitology tests in all patients. RESULTS Presenting complaints were abdominal pain in four patients, with fever in one of the four. All patients also had eosinophilia and abnormal liver function tests. In all patients, US examinations showed multiple hypoechoic nodules or parenchyma heterogeneity. CT examinations showed linear or branching, and nodular hypodense lesions in the liver. As a new imaging finding, hyperdense materials were identified in the dilated bile duct in one patient. MRI showed T1 hypo and T2 hyperintense areas of liver parenchyma in two patients, with peripheral enhancement in one of them. Filling defects and dilation of the intra-extrahepatic bile ducts were identified by US and MRCP in two patients. In these two patients Fasciola flukes were removed by ERCP. Medical treatment (triclabendazole) was successful in all patients. CONCLUSION Hepatobiliary fascioliasis is a rare disease which may have typical imaging findings in the liver and bile ducts as seen in our patients. Imaging characteristics with clinical findings may have a diagnostic clue especially in endemic areas.

Spinal MRI Findings of Guillain-Barré Syndrome

Guillain-Barré syndrome is a relatively common, acute, and rapidly progressive, inflammatory demyelinating polyneuropathy. The diagnosis is usually established on the basis of symptoms and signs, aided by cerebrospinal fluid findings and electrophysiologic criteria. Previously, radiologic examinations have been used only to rule out other spinal abnormalities. We report a case of systemic lupus erythematosus associated with Guillain-Barré syndrome with marked enhancement of nerve roots of the conus medullaris and cauda equina on MR imaging. These MR observations may help confirm the diagnosis of Guillain-Barré syndrome.

Metastatic Pulmonary Calcification in a Patient with Chronic Renal Failure

Metastatic pulmonary calcification characterized by diffuse calcium deposition in the lungs is known to occur in patients with chronic renal failure. We present a case of a 47-year-old man with chronic renal failure presented with dyspnea, high-resolution computed tomography of the chest revealed multiple, centrilobular, calcified nodules and patchy areas of ground-glass opacity throughout both lungs, consistent with metastatic pulmonary calcification. Calcification was also seen in the bronchi and trachea.

Rhabdomyolysis and acute myoglobinuric renal failure in a patient with bilateral pheochromocytoma following open pyelolithotomy.

Rhabdomyolysis is an unusual manifestation of pheochromocytoma. Early diagnosis and prompt management are crucial, as it may have life-threatening consequences. This is the case of a 19-year-old man with bilateral pheochromocytoma complicated with rhabdomyolysis and acute myoglobinuric renal failure after surgery for nephrolithiasis. A massive catecholamine release during the procedure manifested itself as a hypertensive crisis, producing severe vasoconstriction and thereby provoking ischemia of the patients muscle tissue. This insult resulted in rhabdomyolysis and acute myoglobinuric renal failure. After making sure that all necessary medical precautions were performed, including blood pressure stabilization with alpha receptor blockade and adequate fluid replacement, the patient successfully underwent a bilateral cortex-sparing medullar adrenalectomy. The operation specimen was reported as pheochromocytoma.

Localisation using mini c-arm fluoroscopy of needles ingested by a woman with schizophrenia: a case report

IntroductionOur aim was to specify the use of mini C-arm fluoroscopy in a woman with schizophrenia who was suffering from abdominal pain because of ingested needles.Case presentationHere we report the case of an 18-year-old Turkish woman with schizophrenia who was admitted to the emergency department with signs of an acute abdomen as a result of ingestion of multiple needles. This is the third case in the literature for which mini C-arm fluoroscopy has been used to localize metallic sewing needles.ConclusionWhen intentional ingestion occurs, surgery is rarely required. It is hard to localize ingested sewing needles and mini C-arm fluoroscopy is a good alternative when metal detectors are not available for localization of metal sewing needles. We recommend this approach because it helps to avoid unnecessary exploration, shortens the duration of surgery and provides outstanding results.

Diagnosis and treatment of mesenteric tumours.

Abstract Purpose: To reveal clinical and diagnostic findings in patients with mesenteric tumours and to give an insight into the follow-up of these patients. Background: Primary tumours of the mesentery are very infrequent. These tumours are cystic or solid and show benign or malignant clinical behaviour. In this article, we report clinical and radiological findings from eight cases of mesen-teric tumours. Patients and methods: This study included eight patients with mesenteric tumours who underwent computed tomography in the Department of General Surgery, Baskent University, between December 2003 and April 2007. Results: Three mesenteric tumours were solid and five had cystic patterns. Seven were excised totally on laparotomy and one was excised on laparoscopy. None of the patients showed malignant progression. CT showed mesenteric cysts in only two cases, but failed to show solid tumours: the pre-operative diagnosis was made accurately in just (2/8) 25% of the patients. Conclusions: It can be concluded that pre-operative CT is generally helpful, but inconclusive in an accurate diagnosis of mesenteric tumours. Surgery is required to make a definitive diagnosis of mesenteric tumours and to avoid complications.

Epidural and Subdural Spinal Brucellosis

The present paper discusses the characteristics, diagnosis, and treatment of epidural and subdural spinal abscesses, which are the rare complications of brucellosis. Epidural and subdural spinal abscesses have high mortality and their prognosis is quite good with early diagnosis and treatment. There is no standard practice concerning treatment; long-term combined antibiotic therapy, with additional surgical therapy in those having neurological deficit, is required. Attention should be paid particularly for epidural and subdural spinal involvement in the places where brucellosis is endemic.

Value of sonographic anterior-posterior renal pelvis measurements before and after voiding for predicting vesicoureteral reflux in children.

Voiding cystourethrography (VCUG) is the gold standard for diagnosing vesicoureteral reflux (VUR), but it is important to minimize the use of VCUG because of the urinary catheterization and radiation exposure required. Ultrasound (US) observations suggest that pelvicalyceal dilatation varies according to the degree of bladder fullness in children with urinary tract infection. The aim of this study was to assess whether anterior‐posterior (AP) measurements of the renal pelvis on US before and after voiding can be used as a screening tool while predicting the presence of VUR in children.