The effect of maternal fatigue on breastfeeding.

BACKGROUND: Postpartum fatigue means tiredness, sense of suffocation, and decreased physical and mental capacity. Fatigue reduces postpartum women's ability of concentrate, which may increase the frequency of postpartum depression, and their babies and cause babies' weaning off breastmilk earlier. AIM: Postpartum fatigue reduces the ability of mothers to concentrate and has a negative effect on communication between mothers and their babies. This study was performed to determine the effect of fatigue on breastfeeding and breastfeeding behaviors in postpartum women. SUBJECTS AND METHODS: The study had a descriptive desing and was carreid out in a postpartum clinic of a maternal, obstetric, and pediatric diseases hospital. It included 374 women giving normal vaginal birth. Data were gathered with a socio-demographic features form and Visual Analogue Scale for Fatigue. RESULTS: The mean score was 6,91 ± 2,25 for the subscale fatigue and 2,38 ± 0,91 for the subscale energy. The women reporting that it was not difficult to give birth and that they had little or some fatigue had significantly higher scores for energy (P = 0.001). The women starting to breastfeed in the hour of giving birth (P = 0.003) and the women breastfeeding at 1-hour intervals (P = 0.100) had a lower score for fatigue. The women not needing help while breastfeeding had a significantly lower score for fatigue (P = 0.001), while those reporting to give additional food had a significantly higher score for fatigue (P = 0.014). CONCLUSION: Women feel tired in the early postpartum period due to giving birth and their tiredness is increased by breastfeeding and infant care.

Percutaneous endobiliary radiofrequency ablation for refractory benign hepaticojejunostomy and biliary strictures.

PURPOSE: The objective of this study was to determine the safety and efficacy of percutaneous endobiliary radiofrequency ablation (ERFA) and balloon dilation for the treatment of hepaticojejunostomy (HJ) strictures resistant to surgery and/or other interventions. MATERIALS AND METHODS: Eighteen patients who underwent percutaneous ERFA for HJ stricture were included. There were 10 men and 8 women with a mean age of 48.3±10.8 (SD) years (range: 33-69 years). The 18 patients had a total of 29 benign HJ strictures secondary to cholecystectomy (14 patients; 78.0%), Whipple procedure (3 patients; 16.6%) or blunt abdominal trauma (1 patient; 5.4%). The different end-points were technical success, clinical success, recurrence, procedure-related mortality, and morbidity. RESULTS: Technical and clinical success rates were 100% and 83.3%, respectively. No mortality and major procedure-related complications were observed. One patient experienced minor complication (self-limited pleural effusion). Two patients did not show favorable response to ERFA whereas 10 patients had no stricture recurrence during a mean follow-up period of 7.3 months±1.0 (SD) (range: 4-10 months). CONCLUSION: ERFA is a safe and effective treatment for benign HJ and biliary strictures. However, more studies involving more patients with a long-term follow-up period should be made to fully determine the long-term results of ERFA.

[Therapy Goals for Children and Adolescents with ADHD and their Primary Caregivers. A Content Analysis and Examination of Agreement of ADHD Patients and their Primary Caregivers]. / Therapieziele von Kindern und Jugendlichen mit ADHS und ihren Hauptbezugspersonen. Eine inhaltsanalytische Auswertung und Prüfung der Übereinstimmung zwischen Betroffenen und Bezugspersonen.

OBJECTIVE: The aim of this study was to identify individual therapy goals (ITGs) of children and adolescents with ADHD and their primary caregivers. METHODS: Within the evaluation of the selective contract for children and adolescents with ADHD in Bremerhaven, Germany, ITGs of 42 study participants (aged 8-17) and their primary caregivers were collected with the psychotherapy basis documentation for children and adolescents (Psy-BaDo-KJ). ITGs were analysed following the classification of categories for individual therapy goals (KITZ) and their modification for children and adolescents. Analysis focused on the most frequently named ITGs and the agreement of patients and primary caregivers ITGs on the individual level. RESULTS: 235 ITGs were named. The greatest proportion of ADHD patients and their caregivers (47%) focused on interactional, psychosocial conflicts. In 19% of the cases (n=8) patients and their caregivers had the same main goal. 38% of patients and of caregivers (n=16) named the other ones main goal in one of his/her ITGs as well. CONCLUSIONS: ADHD patients and their primary caregivers both pursue ITGs related to ADHD symptoms. Few ITGs address medication related aspects. In case of differences in the ITGs of a patient and his/her primary caregivers, therapists should check whether differing ITGs address the same problem from different perspectives.

Splenic arteriovenous fistula with infarcted spleen.

A 25-year-old woman developed epigastralgia and abdominal bruit in the left hypochondrium. Radiologic investigation included Doppler ultrasonography, angiography and computed tomography and revealed splenic artery aneurysm and arteriovenous fistula resulting in an almost totally infarcted spleen.

Evaluation of the anterior and posterior ethmoidal canal by computed tomography.

AIM: To examine the anatomy, length and angulation of the anterior and posterior ethmoidal canals (AECs and PECs) using computed tomography (CT), and to determine the anatomical landmarks in which the canals are expected to be seen in transverse and coronal planes. MATERIALS AND METHODS: CT images of 150 patients were analysed. One, 2, and 3 mm thick sections were obtained separately in axial and coronal images. The frequency of visualization of the AECs and PECs, and if present, a third canal, was noted. The course and the angulation of the AEC and the PEC in transverse and coronal planes were recorded. On axial sections the distance between the AEC and PEC and the previously defined landmarks were measured. On coronal images, the distances were calculated from the thickness of the cross-section and the number of sections between the various structures. RESULTS: The AEC was identified as a separate canal in 84% of patients, and was embedded in the ethmoid roof in 16%. The PEC was seen as a separate canal in 8% and was present in the ethmoid roof in 92%. On the 1 mm thick coronal and transverse sections, a third canal was identified at the junction of the middle and posterior third of the AEC-PEC distance in both of the images. The average lengths of these canals were 4-12 mm (mean 8.2 mm) for the AEC, and 2-13 mm (mean 7.6 mm) for the PEC. CONCLUSIONS: To avoid the complications that can develop during endoscopic sinus surgery; the course, length and the angulations of the anterior and posterior ethmoidal arteries and their canals can be identified by CT in standard positions if a sufficiently thin section thickness is used. The present study has shown the exact CT localization of the AECs and PECS, which are frequently overlooked when evaluating para-nasal sinuses.

Babinski reflex by sural stimulation and dysfunction of descending motor pathway.

The aim of the study was to find out the relationship between the Babinski reflex and flexor polysynaptic reflexes which was evaluated by sural nerve stimulation, and to evaluate the descending motor pathway in involvement by cervical and transcortical cranial stimulation (TCCS) in a group of patients that were diagnosed as having the Babinski sign with either hemiparetic of hemiplegic, due to a cerebrovascular accident. In the normal population no significant responses were seen from the EHL by sural stimulation and these responses were recorded from the BF with a latency of 88 msec. In the patients who had Babinski reflex responses, signs could be easily recorded from EHL by sural stimulation with a latency of 166 msec. In this group, reflex responses from the BF were recorded with a latency of approximately 100 msec. Responses from the EHL were evaluated in 100% ratio by TCCS with a latency of 33.4 msec. in the normal group. The responses recorded from EHL by TCCS and latency was 47.5 msec. in 35.7% of the patients, who having Babinski sign. In 100% of the normal population, responses were evaluated with a latency of 28.8 msec. from EHL by cervical stimulation. In only 55% of the patients having the Babinski sign, responses were recorded in the same limb with a latency was 32.3 msec. These results support a different mechanism that control the EHL muscle in comparison to the BF muscle having dysfunction of descending motor tracts due to a pyramidal lesion.

Comparison of Tc-99m EC and Tc-99m DTPA captopril scintigraphy to diagnose renal artery stenosis.

PURPOSE: Although, captopril scintigraphy is a well established method to detect renovascular hypertension, the optimal radiopharmaceutical for this test remains to be determined. Recently, Tc-99m ethylenedicysteine (Tc-99m EC) appeared as an alternative agent for captopril scintigraphy. The aim of this study was to compare the diagnostic accuracy of Tc-99m EC with Tc-99m DTPA, which is a well-established renal radiopharmaceutical for the captopril test. METHODS: Nineteen hypertensive patients who had various degrees of renal artery stenosis on angiography were included in the study. All patients had baseline and captopril Tc-99m EC and Tc-99m DTPA scintigraphy within a 1-week period. The results were compared with angiography and in eight patients with changes in blood pressure after revascularization. The images were interpreted without knowledge of the angiography and revascularization data as low, intermediate, or high probability for hemodynamically significant renal artery stenosis, which was defined as an area of stenosis exceeding 50%. RESULTS: Tc-99m EC and Tc-99m DTPA study results were in agreement in 16 of the 19 patients. In two patients with branch artery stenosis, Tc-99m EC was definitely superior to Tc-99m DTPA and correctly identified the probability of stenosis on scintigraphy. On kidney analysis, Tc-99m EC had a slightly greater diagnostic sensitivity compared with Tc-99m DTPA (79% vs. 68%; P > 0.05 by the chi-squared test) but equal specificity (93% for both agents). Both Tc-99m EC and Tc-99m DTPA showed the same accuracy in predicting the outcome after revascularization in all but one patient with branch artery stenosis, in whom Tc-99m EC accurately predicted a successful outcome of the intervention but Tc-99m DTPA did not. Tc-99m EC had better renal uptake in patients with decreased renal function and provided more dramatic evidence of renogram changes after captopril intervention, which resulted in more confident interpretation. CONCLUSIONS: There is no significant difference between Tc-99m EC and Tc-99m DTPA captopril scintigraphy for detecting renal artery stenosis. However, because of the better imaging characteristics and more confident interpretation provided by the dramatic changes in the degree of renogram abnormality after captopril intervention, Tc-99m EC captopril scintigraphy should be used, particularly in patients with decreased renal function or branch artery stenosis.

Marked increase in flow velocities during deep expiration: A duplex Doppler sign of celiac artery compression syndrome.

Symptoms of chronic mesenteric ischemia develop when the celiac artery is constricted by the median arcuate ligament of the diaphragm. Lateral aortography is the primary modality for diagnosing ligamentous compression of the celiac artery. However, duplex Doppler sonography performed during deep expiration can cause a marked increase in flow velocities at the compressed region of the celiac artery and suggest the diagnosis of celiac arterial constriction due to the diaphragmatic ligament.

Pseudoaneurysm of the abdominal aorta diagnosed by color duplex Doppler sonography.

A pseudoaneurysm of the abdominal aorta is rare, accounting for only 1% of all abdominal aneurysms. More than 1 imaging method may be needed to demonstrate an abdominal aortic pseudoaneurysm. We report a case in which the presence of continuous bidirectional flow in the neck of a pseudoaneurysm on color duplex Doppler sonography confirmed the diagnosis.

Doppler waveforms of the normal and collateralized inferior mesenteric artery.

OBJECTIVE: Our purpose was to analyze Doppler waveform changes and the caliber of the inferior mesenteric artery as a collateral vessel in occlusive disease of the abdominal aorta or its main branches. SUBJECTS AND METHODS: Thirty-three patients were examined in three groups according to the location of their occlusive disease (group 1 [n = 5], occlusion of the celiac and superior mesenteric arteries; group 2 [n = 9], occlusion of the iliac artery; and group 3 [n = 19], occlusion of the abdominal aorta distal to the renal arteries). The main truncus of the inferior mesenteric artery was evaluated along its longitudinal axis using color duplex Doppler sonography. Peak systolic velocity, end-diastolic velocity, mean velocity, resistive index, and pulsatility index were determined from the Doppler spectrum. The inner diameter and cross-sectional area of the inferior mesenteric artery were measured, and blood flow volume was calculated. The data obtained from the three groups were compared with data from a control group (n = 24). RESULTS: In all three patient groups, the mean blood flow volume and the mean flow velocities were significantly higher, the mean pulsatility index was significantly lower, and the mean diameter of the vessel was significantly larger than in the control group. The blood flow volume in patients with aortic occlusion was significantly lower than that in patients with superior mesenteric artery occlusion. In the patients with iliac artery occlusion, the mean resistive index was not significantly different from that in the control group. CONCLUSION: An increase in blood flow volume and the presence of a monophasic waveform indicate increased collateral function of the inferior mesenteric artery. However, blood flow volume in patients with aortic occlusion does not increase as high as in patients with superior mesenteric artery occlusion, and a monophasic waveform is not a distinctive finding in iliac artery occlusion.

Severe portal hypertension due to congenital hepatoportal arteriovenous fistula associated with intrahepatic portal vein aneurysm.

A 13-year-old girl was referred for assessment of severe gastrointestinal tract bleeding. Her liver function tests were normal, and she had no evidence of chronic liver disease or history of significant trauma. Clinical and sonographic findings suggested the presence of a portal vein aneurysm associated with a hepatoportal arteriovenous fistula. Abdominal angiography confirmed the diagnosis. The arteriovenous fistula was congenital, and the associated portal vein aneurysm was either congenital or secondary to hemodynamic changes in the portal venous system.

Retroperitoneal fibrosis: evaluation by ultrasonography and color Doppler imaging.

Delay in diagnosis is common in retroperitoneal fibrosis because of the non-specific clinical presentation. Ultrasonography combined with color Doppler imaging is a rapid and practical method in the early diagnosis and during follow-up. We describe 3 cases with retroperitoneal fibrosis, emphasizing the ultrasonographic and color Doppler features of the disease.

Complicated retinal migraine.

Retinal migraine is not uncommon, but permanent sequelae are rare. We describe the case of a 23-year-old woman who had suffered from retinal migraine for five years. After a typical migraine attack a left nasal quadranopsia persisted. Fluorescein angiography showed a branch retinal arterial occlusion. Other causes were ruled out by appropriate laboratory techniques. Her visual field defect has persisted for eleven months.

Persistent primitive proatlantal intersegmental artery (proatlantal artery I) results in 'top of the basilar' syndrome.

BACKGROUND: Persistent primitive proatlantal intersegmental artery (proatlantal artery I) is an anastomotic channel between the carotid and vertebrobasilar arterial systems. Persistence of this embryonic anastomosis is very rare. The "top of the basilar" syndrome is usually due to occlusion of thalamoperforating arteries by emboli that rise from the vertebrobasilar arterial system. In this case, however, the emboli stemmed from atherosclerotic plaques in the carotid system. CASE DESCRIPTION: A 55-year-old woman was hospitalized with top of the basilar syndrome. A brain scan showed hypodense lesions extending from the mesencephalon to both thalami. Digital subtraction angiography of the cerebral circulation was performed, which revealed a proatlantal artery I on the left side. In addition, atheromatous plaques were seen along the internal and common carotid arteries on the same side. CONCLUSIONS: The occurrence of proatlantal artery I is extremely rare. Top of the basilar syndrome is also rarely encountered. To our knowledge, this is the first report of a patient with both conditions.