Sevda Yilmaz

Evaluation of gallbladder volume and motility in non-insulin-dependent diabetes mellitus patients using real-time ultrasonography.

Aims The prevalence of cholelithiasis is 2 to 3 times higher in patients with diabetes mellitus than in the normal population, especially in a group of patients with non–insulin-dependent diabetes mellitus (NIDDM). We investigated the pathogenesis of this increased prevalence by ultrasonography with a brief comparison of demographic features. Materials and Methods The study group was consisted of NIDDM patients (41 males and 47 females, mean age 53.5 ± 11 years), and the control group included healthy volunteers (33 males and 34 females, mean age 50.3 ± 18 years). All patients were investigated after 12 hours of fasting and 30 minutes after a standard test meal. Pre-meal and post-meal gallbladder volumes were used for calculation of the ejection fraction of the gallbladder and fasting gallbladder volume. Results In the study group, there was no correlation between the fasting gallbladder volume and age, parity, and body mass index. However, fasting gallbladder volume and duration of diabetes mellitus showed significant correlation (r = 0.212, P < 0.05). The mean ejection fraction of gallbladders in the study group was 48.48%, whereas that of the control group was 56.32%. There was a significant reduction of ejection fraction in the study group (P = 0.003). Conclusion Our study indicated that there were an increased fasting gallbladder volume and impaired ejection fraction in NIDDM patients. This may be the initiator of bile stasis in the gallbladder and subsequent cholesterol crystal and stone formation.

Endobronchial lipomatous hamartoma: CT and MR imaging features (2004:5b).

Hamartomas may occur in the lung parenchyma or endobronchially. Endobronchial hamartoma is a special form of the usual intrapulmonary hamartoma, which originates from a large bronchus and grows into the lumen. When the tumour becomes large enough, it may obstruct a bronchus causing atelectasis and recurrent pneumonia. Early examination is important for the detection of these tumours, before the lung distal to the obstruction is irreversibly destroyed. If irreversible lung damage has occurred because of chronic obstruction and suppurations, pulmonary resection may be indicated [1]. Endobronchial hamartomas have a low prevalence in all previous studies, and their characteristics are poorly described. There are only five reports about endobronchial lipomatous hamartoma in the literature [2, 3, 4, 5, 6], and MR imaging findings have not been described previously. We report the CT and MR imaging findings of a patient who had an endobronchial lipomatous hamartoma which occluded the superior bronchus of the right lower lobe.

Computed Tomographic Evaluation Before Cranial Bone Harvesting to Avoid Unexpected Hazards During Aesthetic Procedures

Abstract. Nowadays, cranium is the preferred bone-graft donor site for facial aesthetic operations. Preoperative information about the quality of cranial bone, such as bone thickness or presence of the diplopic space, can be useful to minimize intracranial complications. This fact is neglected in reconstructive and aesthetic surgery. The aim of this study is to assess the reliability of Computed Tomography (CT) to determine cranial bone quality. Sixty-four cadaver parietal bones, the preferred site for bone-graft harvesting, were used in this study. In the first stage, posterior parietal bone thickness, which is accepted as the thickest part of cranium, was measured at specially determined points using a micrometer and the results were recorded. Bone thickness was then measured again in the same points with CT. The two methods were compared statistically. The measurements were not found to be statistically different. The similar values obtained with CT and micrometers suggest that CT can accurately and reliably determine cranial thickness. Preoperative CT can be a significant guide for the harvest of cranial bone grafts without any intracranial complications in aesthetic surgery.

Giant arteriovenous malformation located on the chest wall - diagnosis and endovascular treatment: report of a case.

Congenital arteriovenous malformations are usually found in the lower extremities, but a chest wall location is extremely rare. Extensive vascular malformations present difficulties for patients because of severe unsightliness and life-threatening bleeding. Surgical planning and therapeutic indications in vascular malformations are still a difficult problem. This report describes the case of a 27-year-old woman with a congenital giant arteriovenous malformation of the left chest wall. Preoperative embolization was planned prior to surgical intervention because of the increased risk of massive bleeding, and the malformation was completely embolized with absolute alcohol.

Primary hydatid cyst in the retroperitoneal space: role of CT

Abstract. Localization of hydatid disease in the retroperitoneal space is extremely rare. We present the CT findings in a patient with echinococcal disease (E. Granulosus) in whom the cyst was localized to the retroperitoneum.

Perception of bronchoconstriction in obstructive pulmonary diseases (disease-specific dyspnoea)

The perception of dyspnoea differs between subjects with obstructive pulmonary diseases, partly because the underlying mechanisms for bronchoconstriction are different. We investigated the perception of bronchoconstriction in subjects with bronchiectasis, asthma and chronic bronchitis and possible contributing factors. Forty-seven non-smoking subjects with bronchiectasis, 50 subjects with asthma and 31 with chronic bronchitis were challenged with histamine. The Borg score was assessed before and after each challenge. The perception score corresponding to a fall in the forced expiratory volume in 1 s (FEV(1)) by 20% (PS(20)) was calculated. The mean values of DeltaBorg/DeltaFEV(1) (the Borg score change divided by the change in FEV(1) as a percentage of the baseline FEV(1)) and PS(20) of subjects with bronchiectasis and chronic bronchitis were significantly lower than in subjects with asthma after histamine challenge. The ratio of non-perceivers was higher in bronchiectasis (25.5%) and in chronic bronchitis (32.3%) than in asthma (4.0%). When all subjects were considered, DeltaBorg/DeltaFEV(1) values were significantly related to female sex ( r (2)=11.5%, P =0.0001), but not to age, duration of the disease, PD(20) or baseline FEV(1)%. The present study indicates that perception of histamine-induced bronchoconstriction is lower in patients with bronchiectasis and chronic bronchitis than in asthmatic patients, and that sex partially contributes to this difference.

A patient with ileocecal Crohn's disease who has intermittent umbilical and left lower abdominal quadrant pain.

Here in we present a very rare case of Crohn’s disease who had a concurrent intestinal malrotation. A 35-year-old woman was admitted to our outpatient clinic with diagnosis of Crohn’s disease. She had intermittant umblical and left lower abdominal pain. She hadn’t any symptoms during her first 30 years of life. In her past medical history, she has been followed in an external center with the diagnosis of ileocecal Crohn’s disease for 3 years and she was taking 150 mg/day azathioprine and 3 gr/day mesalamine. Her physical examination and labarotory findings were unremarkable. An abdominal ultrasonography showed thickened mucosal layers of ileocecal valve and ileal wall. Also the whole colon segments were isolated to the left side, whereas all jejunal and ileal loops were localized in the right side of the abdomen. In her colonoscopy, ileocecal valve and distal terminal ileum was hyperemic and edometaous (Fig. 1, 2), while an abdominal computerized tomography revealed intestinal malrotation with the colon isolated to the left side and small intestine to the right side (Fig. 3). We did not know about the malrotation and we had many technical problems when we performed the first colonoscopy. Although our cecal intubation time was too long and terminal ileum intubation was too difficult, we cannot recognize correctly the anatomic abnormality. Intestinal malrotation is a congenital anomaly of fetal intestinal rotation that usually presents in the first month of life. It is a failure of rotation of the fetal intestine around the superior mesenteric vessels upon its return from the yolk sack at 10–12 weeks gestation [1]. It occurs with an incidence of 1 out of every 500 births [2]. Clinical symptoms typically occur during the first year of life with abdominal pain and distention. The diagnosis in adults is difficult because of the low incidence in this age group [3], especially if there is no good reason to suspect otherwise. The clinical presentation of malrotation in adults is variable. The most common symptoms are abdominal pain and distention but many patients are asymptomatic. Crohn’s disease primarily causes abdominal pain, diarrhea, vomiting, or weight loss. Right lower abdominal pain may be the initial symptom of ileocecal Crohn’s disease [4]. Although our patient had Crohn’s disease localized to ileocecal region, she had intermittant umbli-