Hepatic arterial mapping by multidetector computed tomographic angiography in living donor liver transplantation.

PURPOSE: Our aims were to present the hepatic arterial variations that were detected with computed tomographic angiography (CTA) and confirmed by operation in living liver donors and to emphasize the usefulness of CTA in the assessment of hepatic arterial anatomy. MATERIALS AND METHODS: The donors of 100 patients (46 women and 54 men) who had undergone a living donor liver transplantation in a (blinded) hospital between July 2004 and June 2007 were evaluated. The age of the donors ranged from 18 to 63 years (mean, 39 years). The CTA images obtained by a 16-slice multidetector CT before the transplantation procedure were retrospectively evaluated for arterial variations, and the results were compared with the results of the operation. RESULTS: In 59 donors (59%), classic hepatic arterial anatomy was observed. In the remaining 41 donors (41%), various arterial variations were determined. In 11 of the donors (11%), variations were not compatible with the description of Michel's classification. In all of our patients, CTA findings were confirmed with operational findings. Our complication rate was 1%. Only 1 of the patients who had undergone the transplantation developed hepatic arterial thrombus, and the remaining 99 patients had no arterial complications. CONCLUSIONS: The course of the vascular structures before live donor liver transplantation is essential for planning and success of the operation. Our study showed that multidetector CTA can be used successfully in hepatic artery imaging of liver transplantation donors as a noninvasive method.

A case with noncoronary sinus of valsalva aneurysm: multidetector computed tomography findings.

We report the case of a 23-year-old man with an unruptured noncoronary sinus of Valsalva aneurysm and Marfan syndrome, which were diagnosed by 16-row multidetector computed tomography (MDCT). MDCT has enabled imaging of the cross-sectional anatomy of the heart with excellent spatial and temporal resolution that reflects the anatomical and functional changes in cardiac pathologies. Thus, the knowledge of the CT anatomy of the heart has become increasingly important for radiologists. This report aimed to confirm the contribution of MDCT in establishing the diagnosis and to show the potential association of nodular septation in the noncoronary sinus of Valsalva with aneurysm.

Crocodile tears syndrome: botulinum toxin treatment under EMG guidance.

Crocodile tears syndrome is one of the rare complications of facial paralysis. There have been several reports of cases in which botulinum toxin was found to be useful in the treatment of crocodile tears syndrome. The adverse effects, due to the paralytic action of botulinum toxin, have been reported to involve the palpebral muscle, lateral rectus and superior rectus. Therefore, we considered that it might be more appropriate to carry out the injection procedure under electromyographic guidance in order to inject botulinum toxin selectively into the lacrimal gland and protect the above-mentioned muscles. In conclusion, we recommend EMG guidance in the treatment of crocodile tears syndrome with botulinum toxin.

Effective management of exposure keratopathy developed in intensive care units: the impact of an evidence based eye care education programme.

OBJECTIVES: To assess the impact of eye care education on the incidence of corneal exposure in intensive care units (ICU). RESEARCH METHODOLOGY/DESIGN: Approximately 300 ICU personnel were educated about eye care to reduce the incidence of corneal exposure. The patients were divided into two groups: pre-training (Group 1: Between February 1, 2011 and March 31, 2011 [2 months]) and post-training periods (Group 2: Between April 1, 2011 and April 1 2012 [1 year]). We compared the groups for keratopathy incidence to evaluate the efficacy of this education. RESULTS: The number of patients were 762 in Group 1 and 6196 in Group 2 (p = 0.335). Medians of patients followed in pre training ICU and post training ICU for each month were found to be 476 (interquartile range, 433-539) and 515 (interquartile range, 490-528). Exposure keratopathy was identified in 8 eyes of 6 patients (3 males and 3 females) in pre training ICU with the mean age of 27.6 ± 31.8 years and 5 eyes of 3 patients (1 male and 2 females) in post training ICU with the mean age of 41.3 ± 32.1 years. No significant difference was noticed between two groups in terms of the medians of patients followed in ICUs for each month (p=0.335). The time of hospitalisation in ICU when the patients were consulted for the first ocular assessment in pre training ICU and post training ICU were found to be 13 ± 8.7 days and 8 ± 1.7 days, respectively. After the training, the decrease in incidence of exposure keratopathy was found to be highly significant (p < 0.001). CONCLUSION: We observed a highly significant reduction in the incidence of corneal exposure, following the eye-care education programme.