Sebuh Kurugoglu

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.

A Child With Primary Sjögren Syndrome and a Review of the Literature

Primary Sjögren syndrome (pSS) is an uncommon disease in childhood. Childhood pSS might have different clinical manifestations than adult pSS. We describe a 13-year-old girl with multiple episodes of bilateral parotid swelling lasting 2 years. Her history included severe arthralgia, local edema, and purpura episodes since 9 years of age. During her 3-week hospitalization, 2 episodes of parotid swelling occurred, which both resolved in 48 hours. Ultrasonography and magnetic resonance images of parotid glands showed parenchymal inhomogeneity related to adipose degeneration and nodular pattern. Investigations showed elevated erythrocyte sedimentation rate, the presence of hypergammaglobulinemia, positive antinuclear antibody, and elevated rheumatoid factor, anti—Sjögren syndrome antigen A, and anti—Sjögren syndrome antigen B. Histopathologic examination of labial minor salivary glands revealed focal periductal lymphocytic infiltrate and sialoduct ectasia. She was diagnosed as having pSS. Recurrent parotid swelling is a more characteristic feature of disease in children, and this finding should alert the clinician to the possible diagnosis of pSS.

Enteroclysis findings of intestinal Behcet disease: a comparative study with Crohn disease

AbstractBackground: The aim of this study was threefold; to define the enteroclysis (EC) findings of intestinal involvement in Behcet disease (BD), to compare these findings with those seen in Crohn disease (CD), and to determine the relation between the duration of BD and severity of the EC findings. Methods: From 1997 to 2000, 17 BD and 50 CD cases were examined by EC examination. EC was performed with a 13-F balloon catheter via transnasal entubation. Mucosal and mural changes were evaluated. Statistical analysis was performed with the Mann-Whitney U test to determine the relation between duration of BD and severity of the EC findings. P ≤ 0.05 was considered statistically significant. Results: In 12 (70.58%) of 17 BD cases, EC demonstrated intestinal pathologic findings such as ulcerations, fold thickening, granular pattern, pseudopolyp formation, and bowel wall thickening. No statistical correlation between the severity of EC findings and the duration of BD was found. Conclusion: EC should be the radiologic method to evaluate the intestinal pathology in symptomatic BD patients. The main EC finding in BD was ulceration mostly in the aphthous form. The EC findings in BD, even in longstanding cases, are usually mild when compared with those seen in CD.

Congenital Imperforate Hymen with Hydrocolpos Diagnosed Using Prenatal MRI

WEB This is a Web exclusive article. mperforate hymen is a rare genital anomaly in which a layer of epithelized connective tissue that forms the hymen has no opening and completely obstructs the vaginal introitus. Hydrocolpos and hydrometrocolpos may occur secondary to this condition. Imperforate hymen usually does not cause symptoms until puberty [1]. This anomaly manifests as an abdominal mass that is detectable during the prenatal period only rarely [2]. We present a case of bilateral hydroureteronephrosis caused by hydrocolpos in a female fetus with an imperforate hymen that was diagnosed using prenatal MRI.

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.

Fatal Trichoderma harzianum infection in a leukemic pediatric patient.

We report the repeated isolation for Trichoderma.harzianum, a rare opportunistic pathogen from three sets of each of the following clinical samples; blood serum, skin lesions, sputum and throat of a pediatric ALL patient with neutropenia. The definition of invasive fungal infection requires evidence of the presence of fungal elements in tissue samples, in addition to the isolation of suspected etiologic agent in culture. However, invasive procedures are not always applicable due to several factors, as for example in our case, the poor general status of the individual patient or thrombocytopenia. The present paper also emphasizes the problems encountered in obtaining appropriate samples and diagnosing invasive fungal disease in immunocompromised patient populations, including those with hematological malignancy. Three cases involving T. harzianum, including this one, have been described thus far in the literature. All were fatal and the fungus was resistant to antifungal therapy. A critical review of the other two cases of Trichoderma infections in humans is provided.

Management of esophageal perforation secondary to caustic esophageal injury in children

PurposeTo review our management of esophageal perforation in children with caustic esophageal injury.MethodWe reviewed the medical records of 22 children treated for esophageal perforations that occurred secondary to caustic esophageal injury.ResultsThere were 18 boys and 4 girls (mean age, 5 years; range, 2–12 years). Three children were treated for perforation during diagnostic endoscopy and 19 were treated for a collective 21 episodes of perforation during balloon dilatation. One child died after undergoing emergency surgery for tracheoesophageal fistula and pneumoperitoneum. Another patient underwent esophagostomy and gastrostomy. Twenty patients were treated conservatively with a nasogastric tube, broad spectrum antibiotics, and tube thoracostomy, 16 of whom responded but 4 required esophagostomy and gastrostomy. Although the perforation healed in 21 patients, 20 were left with a stricture. Two children were lost to follow-up, 8 underwent colonic interposition, and 10 continued to receive periodic balloon dilatations. Two of these 10 patients underwent colonic interposition after a second perforation. The other 8 became resistant to dilatations: 4 were treated by colon interposition; 2, by resection and anastomosis; and 2, by an esophageal stent.ConclusionsEsophageal perforation can be managed conservatively. Because strictures tend to become resistant to balloon dilatation, resection and anastomosis is preferred if they are up to 1 cm in length, otherwise colonic interposition is indicated.

Multiple pulmonary artery aneurysms due to infective endocarditis

Bilateral pulmonary artery aneurysms developed in the course of staphylococcal endocarditis in a 6-year-old girl with ventricular septal defect. Consecutive computed tomography scans revealed the progressive enlargement of one of the aneurysms. She underwent an urgent left upper lobectomy because of the impending rupture and a possible life-threatening hemorrhage. The second ipsilateral aneurysm was plicated in order to exclude the aneurysm sac. In the next operation the ventricular septal defect was closed and vegetations located on the tricuspid valve were removed. On follow-up spontaneous thrombotic resolution occurred in the right-sided aneurysms.

Radiological workup in mesenteric cysts:Insight of a case report

Mesenteric cysts are rare intra-abdominal tumors. The absence of characteristic clinical findings makes diagnosis cumbersome. In this report, the significance of the preoperative radiological workup was discussed in an adult patient with a mesenteric cyst. The complete resection of the cyst is treatment of choice.

Radiological features in paediatric primary gastric MALT lymphoma and association with Helicobacter pylori

Abstract. Primary malignant tumours of the stomach are very rare in children, most being lymphomas and sarcomas. The majority of primary gastric lymphomas are high-grade non-Hodgkins lymphomas and are of B-cell origin. However, a significant number are low-grade B-cell lymphomas that are derived from mucosa-associated lymphoid tissue (MALT) that is not found in the normal stomach. Helicobacter pylori infection predisposes to the development of MALT in the stomach and provides the pathogenic background for MALT-type lymphomagenesis. To our knowledge, only eight paediatric cases of primary gastric lymphoma have been described. The diagnosis and follow-up of gastric lymphoma are mainly made by endoscopy. Nevertheless, radiologists must be aware of this disease because it may be observed on radiological examinations that are performed for non-specific upper digestive symptoms in children.