Surgical treatment of a rare brachial artery aneurysm post-arteriovenous fistula closure after kidney transplant: A case report.

BACKGROUND: Brachial artery aneurysms are defined as dilations greater than 50% of the normal diameter, which are rare among all peripheral arterial aneurysms. While they are often present as pseudoaneurysms, true brachial artery aneurysms are also detected rarely. In this case report, the surgical repair method of true brachial artery aneurysms, which is a rare condition, is explained. CASE SUMMARY: Herein, we present a 61-year-old male patient with complaints of swelling and pain in the right arm antecubital region that had been progressing over 6 mo. Upon the diagnosis of a true brachial artery aneurysm associated with arteriovenous fistula, the aneurysm was surgically repaired with an autologous saphenous vein graft. The patient was discharged without any neurovascular complications postoperatively. CONCLUSION: True brachial artery aneurysms are rare and there are not any recommendations for their management in the current literature. Even though the treatment of true aneurysms in this artery is primarily based on a surgical treatment, endovascular repair also might be an option.

Abdominal aortic aneurysm screening: A pilot study in Turkey.

BACKGROUND: This study aims to evaluate the prevalence of abdominal aortic aneurysm (AAA) in Turkish men aged 60 years and older and the factors associated with AAA. METHODS: Through sixty-two family health centers located in the Kecioren district of Ankara, 239 male volunteers of the target age were recruited for this pilot study. The volunteers were scanned using B-mode ultrasonography. An aorta of 3 cm or larger in outer to outer diameter was accepted as having AAA. The participants were screened for age, height, weight, known diseases and risk factors. RESULTS: AAA was detected in 11 volunteers (4.6%). A history of smoking increased the risk of AAA (Odds ratio: 12.75; CI 95%, 1.2-134.3). The presence of an aneurysm with a history of myocardial infarction (MI) was statistically significant when compared to volunteers without a history of MI (p=0.007). Similarly, volunteers with a history of coronary angiography had a greater risk of an aneurysm than volunteers without (9.5% and 1.9%, respectively). Also, there was a negative correlation between diabetes, peripheral arterial disease, and aortic diameters. CONCLUSION: Although AAA has high mortality rates when ruptured, it is a preventable disease. Therefore, it is necessary to know the prevalence of AAA in Turkey. Our findings were compatible with the literature. However, our study was performed as a pilot study, and there is a need for larger studies in our country.

Iliocaval outflow obstruction in patients with venous ulcers in a small comparison study between patients with primary varicose veins and chronic deep vein disease.

OBJECTIVE: Iliocaval outflow obstruction was investigated in patients with venous ulcers caused by primary superficial disease and chronic deep vein disease METHODS: After clinical assessment, patients with healed or active venous leg ulcers underwent lower extremity duplex ultrasound examination to identify the presence of venous disease in the superficial, deep and perforating systems. Bilateral contrast venography and intravascular ultrasound examination were then performed to determine the presence and degree of iliocaval obstructive lesions. RESULTS: This retrospective study included a total of 59 patients with 71 legs presenting active or healed ulcer. There were 16 limbs (22.5%) with superficial venous reflux associated with normal infrainguinal deep veins (group I) and 55 limbs (77.5%) with infrainguinal post-thrombotic deep venous disease (group II). Using venography and intravascular ultrasound examination, the incidence of >50% of venous obstruction in the iliocaval system in groups I and II were 75% and 83.6%, respectively. All obstructive lesions in group I were nonthrombotic. However, group II included thrombotic, nonthrombotic and combinations of the two types of obstructions. Group II had more ulcers (1.73 ± 1.3 vs 1.17 ± 0.5; P = .03), larger ulcers (>6 cm in 34.1% vs 8.3%), longer duration of ulcers (71.3 ± 110.5 months vs 37.9 ± 40.4 months; P = .03), smaller diameter of refluxing superficial veins (7.7 ± 2.6 mm vs 15.1 ± 6.6 mm; P = .001), and higher incidence of occluded iliocaval systems (18 [32.7%] vs 0; P = .003) than group I. After the exclusion of bilateral cases and thrombotic obstructions, the incidence of >50% nonthrombotic obstruction in ipsilateral and contralateral sides was 76.5% and 24.4%, respectively (P = .003). CONCLUSIONS: The results of this study revealed that the majority of patients with venous ulcers with either infrainguinal primary superficial or post-thrombotic deep venous disease had an element of iliocaval venous obstruction.

Intralesional epidermal growth factor application is a potential therapeutic strategy to improve diabetic foot ulcer healing and prevent amputation.

OBJECTIVES: This study aimed to investigate the efficacy of intralesional epidermal growth factor (EGF) in preventing the extremity from a major amputation and its effects on wound healing in chronic diabetic foot ulcers (DFUs). MATERIAL AND METHODS: Thirty-three patients with DFUs were treated with intralesional EGF application between January 2013 and January 2017. The first endpoint was to determine the prevention rate of major amputation within 12 months following treatment. The second endpoints were the recovery of ulcer surface area with ≥ 50% granulation following two months and the healing of ulcer surface area with ≥ 75% granulation following six months after the first application of EGF. RESULTS: After three patients were excluded because of major side effects in the remaining 30 patients (48 DFUs), granulation rate of ≥ 50% was achieved in 24 (37 DFUs) patients, and not achieved in 6 (11 DFUs) patients eight weeks following the EGF application. A granulation rate of ≥ 75% was achieved in 21 (31 DFUs) patients after six months. At 12 months following the treatment, one major and seven minor amputations were performed, a total of 10 DFUs in five patients were not healed, and the DFUs in 17 patients completely recovered. CONCLUSION: Intralesional EGF application has positive results in addition to good foot care in DFUs, and promising results can be obtained by protecting the extremity from amputation by using it in patients whose vascular intervention methods are not appropriate and have DFUs that do not heal with conventional wound care treatments.

Treatment of hard-to-heal leg ulcers with hyaluronic acid, sodium alginate and negative pressure wound therapy.

OBJECTIVE: Hard-to-heal lower extremity ulcer is a common healthcare problem and can lead to a poor quality of life (QoL). Despite the advances in wound care, conventional therapies, such as necrotic tissue debridement, cleansing, treatment of infection and local treatment with dressing application are still considered the standard of care in patients with hard-to-heal leg ulcers. However, managing hard-to-heal ulcers that do not respond well to these methods has led to new treatment strategies. In this study, the effects of hyaluronic acid (HA) and sodium alginate (SA), combined with negative pressure wound therapy (NPWT), in patients with hard-to-heal leg ulcers are evaluated. METHOD: Patients with hard-to-heal lower extremity ulcers were treated with HA-SA combined with NPWT (HA-SA-NWPT, n=11), or conventional therapy (n=14), between June 2014 and September 2015. Demographics, comorbidities, time to complete healing and change in wound area were recorded and compared. RESULTS: A total of 25 patients took part. Complete healing was achieved in 63.6% (n=7) of the patients in the HA-SA with NPWT group, compared with 14.3% (n=2) of the patients in the conventional therapy group (p=0.017). The mean decrease in wound size was significantly higher in the HA-SA-NPWT group than in the conventional therapy group (73.8% versus 34.8%, respectively, p=0.029). Despite a shorter healing period in the HA-SA-NPWT group than in the conventional group, no statistically significant difference was found between groups for time to complete healing (37 days versus 55 days, respectively). CONCLUSION: These results demonstrate that the combination of HA-SA-NPWT is a promising treatment for decreasing the healing time and increasing the success rate by their synergistic effect on wound healing in hard-to-heal lower extremity ulcers. However, further studies with a larger number of patients are needed to confirm the results.

Popliteal Access in the Supine Position for Endovenous Management of Deep Vein Thrombosis.

INTRODUCTION: The preferred venous access site for percutaneous management of deep venous thrombosis (DVT) is the popliteal vein, with the patient in the prone position. Owing to the need for additional venous access, including the jugular or femoral veins, popliteal access in the prone position requires supine repositioning of the patient. A technique for puncturing the popliteal vein in the supine position is proposed, which allows for additional venous access in the same position in patients with DVT. REPORT: Ultrasound guided popliteal vein access was obtained in the supine position and then pharmacomechanical thrombectomy and iliocaval stent placement was performed for the management of DVT when indicated. DISCUSSION: Eight patients were included (four men, four women; mean ± standard deviation age of 44.2 ± 14.1 years). Popliteal access was performed successfully in the supine position in all patients. An inferior vena cava filter was inserted in five patients and stents were placed in four. Complete recanalisation of occluded vein segments was obtained successfully with popliteal access in supine position in all patients. None of the patients had early or late complications, including arterial puncture, bleeding, haematoma, or neurological disorder. Veins and stents were patent on duplex ultrasound in all seven patients reaching the six month follow up. One patient with patent veins and stents has not yet reached the six month follow up. The technique of popliteal vein access in the supine position for percutaneous endovenous interventions appears to provide a reliable alternative to access in the prone position.

The Predictive Value of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratio in Patients with Recurrent Idiopathic Granulomatous Mastitis.

OBJECTIVE: The aim of this study was to investigate the relationship between the inflammatory parameters including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and the prognosis of idiopathic granulomatous mastitis (IGM). MATERIALS AND METHODS: In this retrospective study, a total of 41 patients with IGM who had no malignant disease or inflammatory pathologies were included between January 2010 and December 2017. The patients were divided into two groups according to presence or absence of recurrence. Subsequently, the relationship between patient characteristics, pre- and postoperative NLR and PLR levels and disease recurrence were evaluated. RESULTS: With a mean follow-up period of 28.4 months, 19.5% of patients were found to have recurrent IGM. Age, body mass index, patient characteristics such as oral contraceptive use, smoking status, and family history, surgical treatment and postoperative NLR, preoperative PLR, and postoperative PLR were not statistically significant between groups. However, only preoperative NLR was significantly associated with a recurrent IGM (p=0.024). Preoperative NLR predicted recurrence with a sensitivity of 62.5% and specificity of 84.8%. CONCLUSION: These results demonstrated that a high level of NLR was predictive of poor outcome in patients with IGM.

A combination treatment of transanal total mesorectal excision and Turnbull-Cutait abdominoperineal pull-through procedure for a low rectal cancer

ABSTRACT Surgical treatment for low rectal cancer has changed dramatically during the preceding several decades, and the optimal surgical approach remains incompletely developed. Transanal total mesorectal excision is likely the most promising approach for the dissection of the distal part of the mesorectum in a manner that allows for a technically easy and oncologically safe operation. Long after it was first described, the Turnbull-Cutait abdominoperineal pull-through procedure has recently been reintroduced in surgical practice for the treatment of patients with complex anorectal conditions. The current report describes a case of distal rectal cancer involving successful surgical treatment with a combination of the two aforementioned methods and patient discharge without a diverting stoma.

RESUMO tratamento cirúrgico para o câncer de reto baixo mudou drásticamente durante as últimas décadas, mas uma abordagem cirúrgica de excelência ainda continua incompletamente desenvolvida. A excisão total do mesorreto por via transanal parece ser a abordagem mais promissora para a dissecção da parte distal do mesorreto de forma a assegurar uma cirurgia oncológicamente segura com uma técnica simples. Muito depois de sua descrição, o pull-through abdominoperineal de Turnbull-Cutait tem sido reintroduzido na prática cirúrgica para o tratamento de pacientes com enfermidades anorretais complexas. Este relato descreve um caso de câncer de reto baixo que se beneficiou de um tratamento cirúrgico bem sucedido a partir da combinação das duas técnicas supracitadas com o paciente recebendo alta hospitalar sem ostomia de proteção.

Clinical Characteristics and Surgical Outcomes of Limb-Sparing Surgery with Vascular Reconstruction for Soft Tissue Sarcomas.

BACKGROUND: The standard treatment for lower extremity soft tissue sarcoma (STS) is limb-sparing surgery. For a small subset of patients, concomitant vascular reconstruction may be required to preserve limb viability and function while completely excising the tumor with an adequate resection margin. The aim of this study was to evaluate the surgical outcomes and clinical characteristics of patients with STS of the extremities requiring vascular reconstructions. METHODS: From January 2002 through December 2014, 13 patients with limb STS presenting with vascular invasion underwent surgical resection, followed by vascular reconstruction. The medical records such as demographics, histopathological findings, complications, success of vascular reconstruction, and clinical and oncological outcomes were retrospectively reviewed from a prospectively collected clinical database. RESULTS: With a mean follow-up period of 80.6 months, a total of 24 vascular reconstruction procedures (1 only arterial, 1 only venous, and 11 both arterial and venous) were performed. Contralateral great saphenous vein graft was the conduit of choice for vascular replacement. Five graft thromboses were observed in 4 patients. Arterial occlusion occurred in two cases, and venous bypasses occluded in three patients. The overall five-year patency for arterial and venous reconstructions was 84.6% and 75.2%, respectively. The mean survival period of patients was 105.5 months, with a 5-year disease-free survival rate and overall survival rate of 59.3% and 68.4%, respectively. CONCLUSIONS: Vascular resection and reconstruction for STSs of extremity can be safely performed with acceptable short- and long-term surgical and oncological outcomes. Regardless of the surgical procedure, amputation or limb-sparing surgery, the primary focus should be to adhere to strict oncological principles. In addition, because of the complexity of these tumors, an appropriate preoperative planning and meticulous multidisciplinary approach are also crucial.

Acute arterial occlusion due to vascular closure device: A report of two cases.

Vascular closure devices are frequently used after percutaneous arterial interventions to achieve hemostasis at the puncture site and facilitate early ambulation. Occasionally, complications have been reported with closure devices, such as hematoma, infection, arteriovenous fistula, pseudoaneurysm, and ischemia. This is a report of 2 cases of severe, acute-onset arterial occlusion and critical limb ischemia, one of which occurred in the upper limb following the use of a vascular closure device, and the required surgical treatment.

Omega-3 fatty acid supplementation does not influence liver regeneration in rats after partial hepatectomy.

AIM OF THE STUDY: In the initiation of liver regeneration, multiple stimulatory and inhibitory factors participate. In this study, we aimed to evaluate the effects of omega-3 fatty acids on liver regeneration after 30% partial hepatectomy in rats. MATERIAL AND METHODS: A total of 14 male Wistar Albino rats were included in this study. The animals were randomly allocated to two groups: the control group (n = 7) and the omega-3 group (n = 7). Rats in the control group were fed a standard rat chow and rats in the omega-3 group received 10 mg/kg/day omega-3 supplementation in addition to normal rat chow in the perioperative period. Rats were investigated seven days after 1/3 partial hepatectomy by liver weight change and hepatocyte proliferation. RESULTS: The mean liver regeneration rate was found to be slightly higher (p = 0.061) in the omega-3 group compared the control group. In addition, no significant difference was observed regarding binuclear hepatocyte ratio in pericentral and periportal areas between the two groups. However, livers from rats given omega-3 supplementation have less inflammatory cellular infiltrate in the portal space than livers from the control group. CONCLUSIONS: Supplementation with omega-3 fatty acids showed no influence on the liver regeneration in rats undergoing 1/3 partial hepatectomy.

The role of fine needle aspiration cytology and core biopsy in the diagnosis of palpable breast masses.

BACKGROUND: The modern approach to palpable breast masses is to get cytopathologic diagnosis before definitive surgery. We aimed to compare fine needle aspiration cytology (FNAC) with core biopsy in histopathologic diagnosis of palpable breast masses. MATERIALS AND METHODS: Data were collected on 123 women who have suspicious palpable breast masses from 2007 to 2010. RESULTS: Of the 123 patients, core biopsies were performed on 64 patients (Group 1) and FNAC on 59 patients (Group 2). Malignancy was confirmed in 25 out of 32 clinically suspicious patients in Group 1 (78.1%), and 20 out of 21 participants in Group 2 (95.2%). Among the clinically suspicious patients, 81.8% of 33 patients in Group 1, and 90.3% of 31 patients in Group 2 were identified malignancy. Sensitivity was 100% for core biopsy and 95% for FNAC. Specificity was 100% in both procedures. False negativity rate in FNAC were 5%. CONCLUSION: Sensitivity and specificity showed that in the case of true histopathologic classification, core biopsy is superior to FNAC. Nevertheless, FNAC's role as a fast, simple and cheap diagnosis cannot be ignored. It is an effective diagnostic tool in most patients, in comparison to the correct and specific typing of core biopsies in benign lesions which protect patients from the open biopsy.

Renal Angiomyolipoma With Caval Extension and Pulmonary Fat Embolism: A Case Report.

Renal angiomyolipoma (AML) is a rare benign tumor of the kidney. Occasionally, it may extend into the renal vein or the inferior vena cava (IVC), but so far of pulmonary embolism in patients with renal AML was rarely reported. Here, a case of symptomatic pulmonary embolism secondary to AML that was placed IVC filter before the operation and then treated with radical nephrectomy is reported.This case highlights the rare possibility of renal vein and IVC involvement with symptomatic pulmonary fat embolism in renal AML, which may potentially result in fatal complications if not appropriately and cautiously managed with surgical intervention.

Splenic infarction as a complication of celiac artery thromboembolism: an unusual cause of abdominal pain.

Splenic infarction is a relatively uncommon diagnosis and this clinical presentation can mimic other causes of acute abdominal pain. Cardiologic and hematologic disorders are common reasons for this entity. There have been a few series and single case reports of splenic infarction published in peer-reviewed medical journals. We report a 53-year-old patient who had splenic infarction caused by celiac artery thromboembolism. The importance of this case, without any etiological predisposing factors, is that this kind of clinical situation should be considered in the differential diagnosis of abdominal pain.