Splenic artery angiography: clinical classification of origin and branching variations of splenic artery by multi-detector computed tomography angiography method.

BACKGROUND: The splenic artery (SA) variations are rarely reported in the literature. Knowledge of the range of the SA and other arterial anomalies and their specific frequencies is very important ever for every visceral surgeon as well as for treatment of gastrointestinal bleeding, organ transplantation, transarterial chemoembolisation of neoplasm, infusion therapy, therapeutic arterial ligation, iatrogenic injuries. At the literature, there are more studies on the coeliac trunk, superior mesenteric artery and hepatic artery variations, but studies on the SA variations are uncommon. The studies on the SA variations are mostly in the form of case reports, but there are not many studies with large population on this issue. The purpose of this study was to evaluate the SA alone and to determine the variations determined separately from the other arteries. Accurate awareness of all the possible anatomic variations is crucial in the upper abdomen surgery. MATERIALS AND METHODS: Seven hundred fifty patients undergoing multi-detector computed tomography angiography between 2015 and 2017 were retrospectively evaluated for the SA variations. We created a new classification system to determine anatomic variations of the SA. RESULTS: Twenty-three different types were identified related to anatomic variations in the origin and branching pattern of the SA. While 596 (79.47%) patients had standard SA anatomy, 154 (20.53%) patients had variant SA anatomy. CONCLUSIONS: The SA has quite different variation types and the practical context of the issue is of primary importance in surgery, gastroenterology, oncology and radiology. Liver and pancreas transplantation, splenectomy, embolisation of tumours of the abdominal organs, as well as other numerous diagnostic and therapeutic procedures, require detailed anatomical knowledge.

LONGER CECUM INSERTION TIME AND MORE INADEQUATE COLONIC PREPARATION IN PATIENTS WITH ACROMEGALY: IS A DIFFERENT COLONOSCOPY PREPARATION NEEDED?

PURPOSE: To investigate whether there is a difference between acromegalic and non-acromegalic cases in terms of bowel preparation and colonoscopic intervention. METHODS: Patients with controlled and uncontrolled acromegaly and as a control group (CG) patients without acromegaly between January 2010 and March 2014 were included. Groups were compared regarding adequacy of bowel preparation, cecal insertion time (CIT) and colonoscopy results. RESULTS: Fifty-nine patients with acromegaly (controlled n=30, uncontrolled n=29) and 73 age and gender matched volunteers without acromegaly were evaluated. CIT in cases with controlled, uncontrolled acromegaly cases and in CG was 5.33 [4.00-6.00], 7.00 [4.91-11.31], and 3.10 [2.35-4.65] minutes, respectively (p<0.001). Cases in CG had shorter CIT compared to controlled and uncontrolled acromegaly cases ( p=0.014 and p<0.001, respectively). There was no significant difference regarding CIT between controlled and uncontrolled acromegaly cases (p=0.247). Six (20%) of controlled acromegaly patients, 10 (35%) of uncontrolled acromegaly patients and three (4%) of CG had inadequate bowel cleansing (p<0.001). Although statistically insignificant, cases with inadequate bowel cleansing had tendency towards having prolonged CIT in comparison to cases with adequate bowel cleansing (6.00 [3.87-9.00] and 4.16 [2.95-5.70] minutes, respectively, p=0.07). CONCLUSION: Inadequate bowel cleansing is one of the main problems encountered during colonoscopic investigation/surveillance in acromegalic patients. Therefore, a different protocol for colonoscopy preparation may be needed for these cases.

The problem of unrecognized acromegaly: surgeries patients undergo prior to diagnosis of acromegaly.

PURPOSE: To reveal the variety of symptoms experienced by patients before acromegaly diagnosis and to emphasize unneeded surgeries that patients undergo related to acromegaly prior to diagnosis of the disease. METHODS: In total, 490 consecutive adult patients with acromegaly who were treated at our institution between 1998 and 2014 were included in this cross-sectional study, of which 313 could be contacted. Participants were questioned about their complaints at initial consultation and at the time of diagnosis, the first medical professional who they consulted, interval between onset and diagnosis, and surgeries they had undergone. RESULTS: This study included 313 participants, of whom 181 were women. The mean age was 48.8 ± 12.0 years. Patients most frequently presented with acral growth of hands and feet (32.6%) and headache (26.2%). Internists were the medical specialists who were most frequently first consulted (29.4%) then neurosurgeons (11.8%). Acromegaly was generally diagnosed by endocrinologists (55%), followed by neurosurgeons (23%). The median elapsed period prior to diagnosis was 24 months, interquartile range 6.0-48.0 months. Some 45.7% had undergone surgery; 35.2% were related to acromegaly symptoms: head and throat surgery (12.8%), nose surgery (9.3%), thyroidectomy (6.4%), carpal tunnel surgery (4.8%). The delay period for patients who had an operation prior to acromegaly diagnosis was significantly longer than for those who had no operations (p < 0.001). CONCLUSIONS: Acromegaly patients mostly present to internal medicine professionals. Surgeries related to acromegaly complications and symptoms before diagnosis cause a long delay period before diagnosis. Medical staff must be more aware of the clinical aspects of acromegaly.

Left ventricular mass in normal children and its correlation with weight, height and body surface area / Masa ventricular izquierda en niños normales y su correlación con el peso, altura y área de superficie corporal

Echocardiographic measurement of left ventricular mass (LVM) is being used for the diagnosis of left ventricular hypertrophy in children with various cardiovascular diseases. The purposes of this study was to establish normal values of LVM according to weight, height and body surface area (BSA) in children and to determine the sex differences. We evaluated 208 children (143 males and 65 females), aged 1 day to 14 years who had no cardiovascular disease. The end-diastolic left ventricular internal dimension (LVIDd), end-diastolic left ventricular posterior wall thickness (LVPWd) and end-diastolic interventricular septum (IVSd) values were determined by M-mode echocardiographic examination. By using these values, left ventricular mass was calculated. The difference between LVIDd, LVPWd and LVM values of boys and girls were not statistically significant . We observed statistically significant differences between the sexes relative to IVSd and LVM/BSA values. The left ventricular mass and its components presented a good correlation with age, weight, height and BSA. The study let us know the lower and upper limits of cardiac dimensions and LVM obtained by echocardiography in normal Turkish children according to BSA. Also, as the LVM/BSA values show gender difference in children, sex should be taken in consideration while evaluating the left ventricular hypertrophy.

La medición ecocardiográfica de la masa ventricular izquierda (LVM) se utiliza para el diagnóstico de la hipertrofia ventricular izquierda en los niños con diversas enfermedades cardiovasculares. Los objetivos de este estudio fueron establecer los valores normales de MVI en función del peso, altura y área de superficie corporal (BSA) en niños y determinar las diferencias entre sexos. Se evaluaron 208 niños (143 varones y 65 mujeres), con edades entre 1 día a 14 años de edad que presentaban enfermedades cardiovasculares. Se determinaron los valores interno al final del diástole ventricular izquierdo (LVIDd), el espesor de la pared posterior (LVPWd) y el tabique interventricular (IVSd) mediante el examen ecocardiográfico en modo M. Utilizando estos valores, fue calculada la masa ventricular izquierda. Las diferencias de los valores LVIDd, LVPWd LVM entre niños y niñas no fueron estadísticamente significativas. Observamos diferencias estadísticamente significativas entre los sexos en relación con los valores IVSd y LVM/BSA. La masa ventricular izquierda y sus componentes presentaron una buena correlación con la edad, peso, altura y BSA. Este estudio nos permitió conocer los límites superior e inferior de las dimensiones cardíacas, junto a la LVM obtenidas mediante ecocardiografía en niños turcos normales de acuerdo con el BSA. Además, como los valores LVM/BSA muestran diferencias entre sexos en los niños, el sexo se debería tomar en consideración al evaluar la hipertrofia ventricular izquierda.

Congenital anomalies of left renal vein and its clinical importance: a case report and review of literature.

Detailed knowledge of the anatomy and anomalies of renal veins is necessary for retroperitoneal surgery and venographic procedures. According to Thomas (1970, Arch. Surg. 100: 738-740), the anomalies of renal veins are more frequent than estimated. The number of surgical procedures and radiologic examinations related to the retroperitoneum are increasing, and therefore pathologic conditions of the retroperitoneal area have been discussed more frequently. We report on a retroaortic left renal vein joining the left common iliac vein, discuss the embryology and clinical importance of renal vein anomalies, and give an overview on the relevant literature.