Turkmen Ciftci

Percutaneous transhepatic drainage of inaccessible postoperative abdominal abscesses.

OBJECTIVE The purpose of this study was to evaluate the safety and efficacy of transhepatic drainage of inaccessible postoperative intraabdominal abscesses under sonographic and fluoroscopic guidance. MATERIALS AND METHODS Between February 2005 and September 2010, 30 abscesses were treated in 30 patients. Procedures were performed with sonographic and fluoroscopic guidance under i.v. sedation and local anesthesia. Factors affecting results were evaluated statistically. RESULTS The technical and clinical success rates were 100% and 97%. The procedures were performed with 8-, 10-, and 12-French locking pigtail catheters. The catheters were in place for a mean duration of 75 days if a fistula was present and 15 days in the absence of fistula. Major complications were not detected during treatment. The rate of minor complications (catheter dislodgement, obstruction, kinking) was 20%. Most of the complications were managed by exchange, revision, or increase in size of the catheter. When use of an 8-French catheter was compared separately with use of 10- and 12-French catheters, the rate of minor complications was found to be significantly higher for the 8-French group (p < 0.05). Five abscesses had fistulous communication with the pancreatic duct, jejunum, and biliary system. The mean duration of catheter use was increased by the presence of a fistula (p < 0.05). When single-microbe, polymicrobial, and culture-negative abscesses were compared, the difference between groups with respect to mean duration of catheter use was not statistically significant (p > 0.05). Mean duration also did not differ significantly between patients with an abscess volume greater than and those with an abscess volume less than 100 mL (p > 0.05). CONCLUSION Transhepatic drainage of intraabdominal abscesses under sonographic and fluoroscopic guidance is safe and effective. Abscess content and volume did not affect drainage time, but the presence of a fistula increased the duration of catheter use. The rate of catheter-related complication was highest in the group with 8-French catheters. The rates in the groups with 10- and 12-French catheters did not differ significantly. We suggest the use of 10-French catheters for transhepatic drainage.

US-guided botulinum toxin injection for excessive drooling in children

PURPOSE We aimed to evaluate the safety and efficacy of botulinum toxin A (BTX-A) injections under ultrasonography (US) guidance for children with excessive drooling. MATERIALS AND METHODS Between January 2006 and January 2011, 44 BTX-A injections into bilateral submandibular glands were performed in 20 children (mean age, 9.1 years; range, 3-16 years; gender, 15 boys and 5 girls) under intravenous sedation. Efficacy of the injections was evaluated 4-12 weeks after the injection. Severity of drooling was assessed using the Teacher Drooling Scale (TDS). If the patient or the patients caregiver reported a good initial response, injections were then repeated periodically when drooling reached the preinjection score. If there was no response or suboptimal response, a booster injection of BTX-A was given after one month. RESULTS Technical success rate was 100%. No procedure-related major or minor complication was detected. One family (5%) reported intermittent problems with swallowing due to viscous saliva. A successful outcome was defined as a minimum two point reduction in TDS score. This outcome occurred for 8 of 20 patients four weeks after the first injection. After consecutive sessions, clinical success was achieved at the end of the 12 weeks for 16 patients (80%). The mean TDS score decreased from 4.75 to 2.1 at the end of the study for all patients (P < 0.05). Four patients did not respond to BTXA injection. Submandibular resection was applied to 3 of 4 unresponsive patients. Two patients had complete remission after surgery, but one patient showed excessive drooling that could not be controlled. CONCLUSION US-guided submandibular BTX-A injection is a safe and effective procedure in treating drooling in children. It can be performed under intravenous sedation and does not require general anesthesia.

Comparison of Long-Term Results of Percutaneous Treatment Techniques for Hepatic Cystic Echinococcosis Types 2 and 3b

OBJECTIVE The purpose of this study was to determine the long-term results of a modified catheterization technique for percutaneous treatment of hepatic cystic echinococcosis (CE) types 2 and 3b and to retrospectively compare the results of puncture, aspiration, injection, and reaspiration (PAIR); standard catheterization; and the modified catheterization technique. MATERIALS AND METHODS Seventy-three patients (37 male, 36 female; 75 cysts) with CE types 2 and 3b who underwent percutaneous treatment from March 1991 to August 2008 were included. Informed consent from all patients and approval of the ethics board were obtained. Patients were 6-79 years old. Twenty-three cysts (30.6%) were treated with PAIR, 26 (34.7%) with standard catheterization, and 26 (34.7%) with the modified catheterization technique. The results of the three techniques were statistically compared. RESULTS Among all patients, the cysts decreased in volume by 61.1% (range, 5-100%). Cysts recurred in 11 (47.8%) patients treated with PAIR, three (11.5%) treated with standard catheterization, and one (3.8%) treated with the modified catheterization technique. The recurrence rate was not significantly different between standard catheterization and the modified catheterization technique (p > 0.05), whereas significantly more recurrences developed after PAIR than with the other two techniques (p < 0.05). Twelve (16.4%) major and 16 (21.9%) minor complications developed. Significantly fewer major complications occurred with PAIR than with the modified catheterization technique, but the difference between standard catheterization and the other two techniques was not significant. CONCLUSION Treatment of CE types 2 and 3b with the modified catheterization technique was associated with a recurrence rate lower than what is seen with other techniques, and therefore it appears to be a safe, reliable, and efficient alternative.

Radiofrequency ablation for lung tumors: outcomes, effects on survival, and prognostic factors.

PURPOSE We aimed to evaluate the survival benefit achieved with radiofrequency (RF) ablation of primary and metastatic lung tumors and determine significant prognostic factors for recurrence-free survival. METHODS Forty-nine patients with lung cancer (10 primary and 39 metastatic) underwent computed tomography-guided percutaneous RF ablation between June 2005 and October 2013. A total of 112 tumors (101 metastatic and 11 primary non-small cell lung cancer) were treated with RF ablation. Tumor diameter ranged from 0.6 to 4 cm (median 1.5 cm). Effectiveness of treatment, complications, and survival were analyzed. RESULTS Primary success rate was 79.5% and local tumor progression occurred in 23 tumors. Among tumors showing progression, 10 were re-treated with RF ablation and secondary success rate was 87.5%. One-, two-, and three-year overall survival rates of 10 patients with primary lung cancer were 100%, 86%, and 43%, respectively. One-, two-, three-, four-, and five-year overall survival rates for 39 patients with metastatic lung tumors were 90%, 73%, 59%, 55%, and 38%, respectively. One-, two-, three-, and four-year overall survival rates for 16 patients with colorectal pulmonary metastases were 94%, 80%, 68%, and 23%, respectively. Complications occurred in 30 sessions (24.6%). Pneumothorax occurred in 19 sessions with seven requiring image-guided percutaneous chest tube drainage. Tumor status (solitary or multiple) and presence of extrapulmonary metastasis at initial RF ablation were significant prognostic factors in terms of recurrence-free survival. CONCLUSION RF ablation is a safe and effective treatment with a survival benefit for selected patients with primary and secondary lung tumors.

Radiologically placed tunneled peritoneal catheter in palliation of malignant ascites

The purpose of this study was to evaluate retrospectively the safety and effectiveness of radiologically placed tunneled peritoneal catheter in palliation of malignant ascites. Between July 2005 and June 2009, 41 tunneled peritoneal catheters were placed under ultrasonographic and fluoroscopic guidance in 40 patients (mean age, 55 years; 22 women) who had symptomatic malignant ascites. No procedure related mortality was observed. Major complication occurred in one patient (2.5%) in the form of serious bacterial peritonitis that necessitated catheter removal. Minor complications such as minor bacterial peritonitis, catheter dislodgement, tunnel infection, and catheter blockage occurred in 11 patients (27.5%). The mean duration of survival after catheter placement was 11.8 weeks. All patients expired of their primary malignancies in the follow-up. Radiologically placed tunneled peritoneal catheter is safe and effective in palliation of symptomatic malignant ascites.

Mesenteric angiography of patients with gastrointestinal tract hemorrhages: a single center study.

PURPOSE This retrospective study was designed to investigate the transcatheter mesenteric angiography of patients with gastrointestinal (GI) bleeding and to determine the most important variables that should be monitored in patients with GI bleeding prior to transcatheter arteriography. MATERIALS AND METHODS In this study, we evaluated the transcatheter mesenteric angiography results of patients with massive GI bleeding (defined as hypotension, tachycardia, and a greater than 4-unit blood transfusion requirement in 24 h) seen between 2005 and 2009. Detailed clinical follow-up and accessible hospital data from 45 procedures were examined from 42 patients (two procedures were performed in three patients) between 24 and 85 years old (mean age, 57.6 years). The present study included 33 males and 9 females. Angiography was performed for lower GI bleeding in 22 patients, upper GI bleeding in 15 patients, and upper/lower (multiple origins) GI bleeding in five patients. Imaging work-ups, including endoscopic interventions, and follow-ups with patients after the procedure were evaluated in detail. Several variables recorded prior to the procedure, including the clinical status, etiological cause of the bleeding, bleeding parameters (e.g., international normalized ratio, platelets), imaging workup, gender, season, and angiography time, were examined. RESULTS Embolization was performed in 24 (53%) of the 45 procedures. Overall, the technical success rate of the diagnostic arteriograms was 100%, and no major complications occurred. For the embolizations, coils were used in 17 patients (70%), polyvinyl alcohol particles were used in six patients (25%), and n-butyl cyano-acrylate was used in one patient (4%). The detection rate of mesenteric arteriographies to examine GI bleeding performed outside of normal working hours was significantly greater than the detection rate of the arteriographies performed during normal working hours (P = 0.050). Low platelet levels or a prolonged prothrombin time were not associated with the mesenteric arteriography results (P = 1.00). Interestingly, the intermittent nature of GI bleeding was the most challenging part of detection, which made management of the bleeding difficult. Blind embolization of the left gastric artery was only helpful in preventing massive bleeding in three out of eight patients with upper GI bleeding. CONCLUSION Endoscopy for upper gastrointestinal bleeding and scintigraphy for lower gastrointestinal bleeding are important steps in the management and outcome of transcatheter angiography. Computerized tomography angiography is a promising tool for the treatment of both upper and lower GI bleeding, and this procedure has become part of the imaging toolset. In addition, angiography performed outside of working hours had a higher rate of clinical success than the angiographies performed in working hours, most likely secondary to much appropriate timing of arteriogram in terms of critical bleeding intervals.

Prevalence of abdominal cystic echinococcosis in rural Bulgaria, Romania, and Turkey: a cross-sectional, ultrasound-based, population study from the HERACLES project

BACKGROUND Cystic echinococcosis is a neglected zoonotic infection that is distributed worldwide and prioritised by WHO for control efforts. The burden of human cystic echinococcosis is poorly understood in most endemic regions, including eastern Europe. We aimed to estimate the prevalence of abdominal cystic echinococcosis in rural areas of Bulgaria, Romania, and Turkey. METHODS We did a cross-sectional ultrasound-based survey that recruited volunteers from 50 villages in rural areas of Bulgaria, Romania, and Turkey. These villages were in provinces with annual hospital incidence of cystic echinococcosis within the mid-range for the respective countries. All people who attended a session were allowed to participate if they agreed to be screened. Abdominal ultrasound screening sessions were hosted in public community structures such as community halls, primary health-care centres, schools, and mosques. Lesions were classified using an adapted WHO classification. We reported the prevalence of abdominal cystic echinococcosis adjusted by sex and age through direct standardisation, using the countrys rural population as a reference. FINDINGS From July 1, 2014, to Aug 3, 2015, 24 693 individuals presented to screening sessions and 24 687 underwent ultrasound screening. We excluded a further six indivduals due to missing data, leaving 24 681 people in our analysis. Abdominal cystic echinococcosis was detected in 31 of 8602 people screened in Bulgaria, 35 of 7461 screened in Romania, and 53 of 8618 screened in Turkey. The age and sex adjusted prevalence of abdominal cystic echinococcosis was 0·41% (95% CI 0·29-0·58) in Bulgaria, 0·41% (0·26-0·65) in Romania, and 0·59% (0·19-1·85) in Turkey. Active cysts were found in people of all ages, including children, and in all investigated provinces. INTERPRETATION Our results provide population-based estimates of the prevalence of abdominal cystic echinococcosis. These findings should be useful to support the planning of cost-effective interventions, supporting the WHO roadmap for cystic echinococcosis control. FUNDING European Union Seventh Framework Programme.

Pyelolymphatic backflow demonstrated by an abdominal CT: A case report.

Summary Background Pyelolymphatic backflow phenomenon, which is a subtype of pyelorenal backflow, is a rare condition that occurs during the acute phase of urinary obstruction. Pyelorenal backflow has already been described in humans with retrograde pyelography. Our report presents a rare case of pyelolyphatic backflow demonstrated by a computed tomography. Case Report A 67-year-old man with a history of bladder carcinoma was admitted to the emergency department due to right-sided flank pain and hematuria. Hematuria resolved after insertion of a 3-way urinary catheter, but flank pain persisted. As a result, an abdominopelvic CT was performed. CT revealed numerous tiny, serpiginous tubular structures connected with each other and filled with urine. They began intrarenally and extended caudally surrounding the ureter in the retroperitoneum. Subsequently, the patient underwent an ultrasound-guided nephrostomy to decompress the collecting system of the right kidney. Antegrade pyelography revealed minimal hydroneprosis. However, no leakage from the ureter to the retroperitoneum was observed, proving that the changes demonstrated by a CT were due to pyelolymphatic reflux caused by increased pressure in the collecting tubules filling the lymphatics with opaque urine. Conclusions This report presents a very rare case of pyelolymphatic reflux demonstrated by a CT. We present this case report as a reminder that although rare, pyelolymphatic reflux can occur as a result of obstruction without manifestations of hydronephrosis and it can be confused with leakage from the ureter.

Human cystic echinococcosis in Turkey: a preliminary study on DNA polymorphisms of hydatid cysts removed from confirmed patients

Cystic echinococcosis caused by the larval stages of Echinococcus granulosus sensu lato s.l is endemic in Turkey with a high public health impact particularly in rural areas. The aim of this study was to investigate the genetic variation and population structure of E. granulosus s.s using metacestode isolates removed from surgically confirmed patients originating from several regions in Turkey and to investigate the occurrence of autochthonous transmission. Using DNA extracted from a total of 46 human-derived CE isolates, we successfully analysed an 827-bp fragment within the cox1 mitochondrial gene and confirmed the causative agent of human cystic echinococcosis in patients included in this study to be Echinococcus granulosus s.s (G1 and G3 genotypes). The haplotype parsimony network consisted of 28 haplotypes arranged within three main clusters and the neutrality indices were both negative and significant indicating negative selection or population expansion. The assessment carried out in this study using GenBank nucleotide sequence data from Turkey for sheep and cattle hosts demonstrated the importance of autochthonous transmission with sheep, cattle and humans harbouring the same haplotypes. Further studies are required to investigate the biological significance, if any, of E. granulosus s.s haplotypes and the genetic variability of CE from human patients using longer nucleotide sequences and a larger sample set.

Pleurodesis through Pleural Catheterization in Patients with Symptomatic Malignant Pleural Effusions: Which One is better? Talc, Bleomycin or Tetracycline?

Purpose: To analyze the results of pleurodesis through pleural catheterization using talc slurry, bleomycin, and tetracycline in patients with symptomatic malignant pleural effusion (MPE) and to compare the efficacy, reliability and outcomes of these agents. Methods: Talc (4 g), bleomycin (60.000 U) or tetracycline (1 g) was used for chemical pleurodesis in 271 patients. Successful pleurodesis was defined as no fluid build up and lack of recurrence of symptoms within the first 30 days after treatment. Data were analyzed using SPSS 15.0 for Windows. Results: Pleural catheterization was performed in a total of 368 patients. Eighteen patients were lost to follow-up. Seventy-nine patients were excluded due to either of the following factors; trapped lung syndrome or patient lost during the early post-catheterization period due to advanced disease. In 271 patients chemical pleurodesis was performed with talc slurry (17.3%), bleomycin (13.7%) or tetracycline (49.1%). In 19.9% of the patients, multiple chemical agents were used in different sessions as successful results were not obtained with one agent. Clinical and radiological success was achieved in 78.2% of patients. There was no significant difference among 4 groups (talc slurry, bleomycin, tetracycline and multiple agents) in terms of clinical success, complication rates and median symptom-free life periods. Conclusion: Talc slurry, bleomycin, or tetracycline administration through percutaneous pleural catheterization have comparable efficacy rates and safety profiles. If pleurodesis failure with one agent occurs, the attempt with other agents may result in success.