Can platelet count/spleen diameter ratio be used for cirrhotic children to predict esophageal varices?

AIM: To determine the laboratory and radiologic parameters, including the platelet count (PC)-to-spleen diameter (SD) ratio as a non-invasive marker that may predict the presence of esophageal varices (EV) in children with cirrhosis. METHODS: Eighty-nine patients with cirrhosis, but without a history of variceal bleeding were prospectively included. The children were grouped into 6-12 and 12-18 years of age groups. These groups were also divided into 2 sub-groups (presence and absence of EV). All of the patients underwent a complete biochemical and radiologic evaluation. The PC (n/mm3)-to-SD (mm) ratio was calculated for each patient. RESULTS: Sixty-nine of 98 (70.4%) patients had EV. The presence of ascites in all age groups was significantly associated with the presence of EV. There were no differences in serum albumin levels, PC, SD and the PC-to-SD ratio between the presence and absence of EV groups in both age groups (P > 0.05). CONCLUSION: Laboratory and radiologic parameters, including the PC-to-SD ratio as a non-invasive marker (except for the presence of ascites), was inappropriate for detecting EV in children with cirrhosis.

Noninvasive imaging findings of idiopathic renal arteriovenous fistula.

Renal arteriovenous fistula (AVF) is an uncommon clinical entity, which can be congenital, acquired, or idiopathic. Diagnosis is aided by radiological studies, with digital subtraction angiography as a gold standard. However, Doppler ultrasound with color Doppler interrogation and computed tomography (CT) angiography are alternative imaging techniques that are noninvasive and can be used for patients to whom no intervention is planned. In this report, we present a case of idiopathic renal AVF diagnosed by Doppler ultrasound and CT angiography. Grayscale ultrasound showed a cyst-like lesion which was confirmed to be a focal aneurysmatic dilatation with heterogeneous fill-in and turbulent blood flow on color Doppler and spectral analysis. CT angiography demonstrated multiple aneurysmatic dilatations of the segmental branch and early opacification of right renal vein on the arterial phase, consistent with renal AVF.

Various origins of the duplicated middle cerebral artery.

We describe the features of a duplicated middle cerebral artery identified by computed tomographic angiography that originates from a previously undefined origin, ie, from the petrous portion of the internal carotid artery. Recognition of this anomaly is important in patients with a possible aneurysm, which was not present in our patient.

A case with mature B-cell acute lymphoblastic leukemia and pancreatic involvement at the time of diagnosis.

Pancreatic infiltration with leukemic cells is a rare manifestation of acute lymphoblastic leukemia. There are only a few reported cases. We report the clinical and radiologic findings of a 4-year-old boy with mature B-cell acute lymphoblastic leukemia and pancreatic involvement. A computed tomography scan of his abdomen demonstrated diffuse hypodense lesions in the pancreas. Plasma amylase and lipase levels at that time were high, but no signs of hypoglycemia or hyperglycemia were observed. After 2 cycles of chemotherapy, the lesions in his pancreas, liver, and kidney disappeared, and his pancreatitis resolved as well. At 11 months' follow-up, after completion of therapy, the patient continues to be in remission.

An uncommon cause of acute abdomen--epiploic appendagitis: CT findings.

Epiploic appendagitis, which is an uncommon cause of acute abdomen, is a benign self-limiting inflammatory process of epiploic appendices. It has primary and secondary types. Computed tomography findings of the primary type are specific but are demonstrated rarely. Herein, we present pre- and post-treatment computed tomography findings of two cases who admitted to the emergency clinic with acute abdominal pain and were diagnosed to have epiploic appendagitis. Follow-up computed tomography features correlated well with clinical improvement.

Effects of orlistat plus diet on postprandial lipemia and brachial artery reactivity in normolipidemic, obese women with normal glucose tolerance: A prospective, randomized, controlled Study.

BACKGROUND: Postprandial lipemia (PPL) is an independent predictor of earlyatherosclerosis and coronary artery disease. It is defined as a postprandial triglyceride (TG) level ≥80% higher than the fasting level. Brachial arterial reactivity (BAR) is used to identify early-phase atherosclerosis. Data concerning whether orlistat improves PPL and endothelial function are lacking. OBJECTIVE: The aim of this study was to determine the effects of orlistat on PPL and BAR in normolipidemic, obese women with normal glucose tolerance. METHODS: This prospective, randomized, controlled study was conducted at Baskent University, Ankara, Turkey. Normolipidemic, obese women aged 18 to 65 years with normal glucose tolerance were eligible for screening. On screening, demographic information, anthropomorphic parameters (body mass index [BMI], waist circumference [WC], hip circumference, waist-hip ratio), BAR, laboratory test results (level of insulin resistance assessed using the homeostasis model assessment-insulin resistance [HOMA-IR] index, serum lipid profile, fasting plasma levels of glucose and insulin [FPI]), and oral fat-loading test results were recorded as baseline values. The primary end points were the effects of orlistat + diet on PPL (assessed using the AUC of TG) and BAR. Women found on screening to be PPL positive were randomly assigned in a 2:1 ratio to treatment with orlistat 120 mg TID plus low-calorie diet (600-kcal/d deficit; minimum, 1200 kcal/d) or low-calorie diet only (control) for 12 weeks. After 12 weeks, all of the above assessments were repeated, and AUC values for lipid parameters were calculated as secondary outcome measures. To assess tolerability and compliance, women were monitored by telephone each week and instructed to return every 4 weeks for clinic visits. RESULTS: Twenty-seven women were identified as PPL positive and assigned to the orlistat + diet group (18 subjects) or the control group (9) (mean [SD] age, 45.9 [2.3] years; mean [SD] weight, 87.4 [2.5] kg; mean [SD] BMI, 36.0 [0.8] kg/m(2)). Treatment with orlistat + diet was associated with significantly greater changes from baseline compared with controls in WC (P= 0.003), fasting and postprandial serum TG levels (P = 0.012 and P < 0.001, respectively), FPI level (P = 0.001), and HOMA-IR index (P < 0.001). Logistic regression analysis found that 12 weeks of treatment with orlistat + diet was associated with a numeric, but statistically non-significant, 4.1-fold change in PPL, which was independent of reductions from baseline in weight and WC. Neither treatment was associated with significant changes from baseline in BAR. The prevalences of gastrointestinal symptoms previously found to be related to orlistat use were statistically similar between the orlistat + diet and control groups (9 [50.0%] vs 3 [33.3%] subjects). CONCLUSIONS: The results of this small study in normolipidemic, obesewomen with normal glucose tolerance suggest that 12 weeks of treatment with orlistat 120 mg/d plus low-calorie diet was associated with a numeric, but statistically nonsignificant, 4.1-fold change from baseline in PPL, which was independent of reductions from baseline in weight and WC. Treatment with orlistat + diet was associated with significant effects on WC, TG, and level of insulin resistance, but not BAR.

In vivo and in vitro effects of stellate ganglion blockade on radial and internal mammary arteries.

OBJECTIVE: To investigate the effects of stellate ganglion blockade (SGB) on the internal mammary (IMA) and radial arteries (RA) in patients undergoing coronary artery bypass graft (CABG) surgery with in vivo and in vitro studies. DESIGN: Prospective, randomized trial. SETTING: University hospital. PARTICIPANTS: Thirty-seven patients undergoing CABG surgery. INTERVENTIONS: SGB was performed on 19 patients before anesthesia induction. Another group of 18 patients underwent surgery without SGB. Diameters of proximal RA, distal RA, and IMA were determined by Doppler ultrasonography before (T1) and after (T2) anesthesia induction. Control or blocked IMA and RA segments were obtained. Norepinephrine (NE) was applied to determine the contractile force of IMA and RA rings in a concentration-dependent manner. The maximal contractile response and the sensitivity of the vessels were compared. MEASUREMENTS AND MAIN RESULTS: The diameters of IMA and distal RA were statistically larger in the SGB group than those in the control group at T2. NE-induced maximum contraction was higher in the blocked RA rings than those in the control RA and blocked IMA rings. The sensitivity of IMA segments to NE was higher than that of RA segments in the SGB group. The control and blocked IMA segments showed similar sensitivity to NE. CONCLUSION: The present results show that SGB not only increases distal RA and IMA diameters but is also associated with in vitro differences, the mechanism of which remains to be elucidated. Therefore, SGB might be considered as an alternative to topical and systemic vasodilators for reducing vasospasm in patients undergoing CABG.

Percutaneous introduction of a snare for removal of migrated biliary stents.

This report describes two cases in which proximally migrated Amsterdam-type biliary stents were extracted using transhepatic snare introduction into the bile ducts. In one case, the migrated stent was removed transhepatically via a percutaneous approach, and in the other a combination transhepatic-endoscopic extraction was successful. No complications were encountered. Percutaneous introduction of snare via transhepatic route offers a good alternative to surgery for removal of migrated biliary stents.