Pregnancy and Crimean-Congo haemorrhagic fever.

Crimean-Congo Hemorrhagic fever (CCHF) is a potentially fatal viral infection with reported case fatality rates of 5-30%. Humans become infected through tick bites, by contact with a patient with CCHF during the acute phase of infection, or by contact with blood or tissues from viraemic livestock. In this first report in the literature, we present the characteristics of three pregnant women with CCHF infection and the outcome of their babies. Transmission of the CCHF infection could be either intrauterine or perinatal. In endemic regions, CCHF infection should be considered in the differential diagnosis of HELLP syndrome (haemolytic anaemia, elevated liver enzymes, low platelet count), and obstetricians should be familiar with the characteristics of CCHF infection. In the aetiology of necrotising enterocolitis, CCHF should be considered.

Persistent primitive hypoglossal artery and fenestration of posterior cerebral artery: CT and MR angiography.

Persistent primitive hypoglossal artery (PPHA) which is a persistent carotid-basilar anastomosis is a rare vascular anomaly. It is usually found incidentally. Fenestrations of cerebral arteries are uncommon. Herein we present a case of PPHA with fenestration of posterior cerebral artery. A 28 year old man was admitted to our hospital with complaints of dizziness and temporary loss of vision. Neurological examination revealed no abnormal findings. The patient was further evaluated with CT and MR angiography. To our knowledge, the case we reported is the first case in the literature with PPHA and fenestration of posterior cerebral artery. The detection of PPHA and associated vascular anomalies and diseases are important before surgical and interventional procedures. CT and MR angiography are much safer diagnostic alternatives in the detection of PPHA and fenestrations. When PPHA is detected, attention should be given to the coexistent posterior circulation anomalies.

Persistent primitive hypoglossal artery and fenestration of posterior cerebralartery: CT and MR angiography

Persistent primitive hypoglossal artery (PPHA) which is a persistent carotid-basilar anastomosis is ar are vascular anomaly. It is usually found incidentally. Fenestrations of cerebral arteries are uncommon. Herein we present a case of PPHA with fenestration of posterior cerebral artery. A 28 year old man was admitted to our hospital with complaints of dizzinessand temporary loss of vision. Neurological examination revealed no abnormal findings. The patient was further evaluated with CT and MR angiography.To our knowledge, the case we reported is the firstcase in the literature with PPHA and fenestration ofposterior cerebral artery. The detection of PPHA and associated vascular anomalies and diseases are important before surgical and interventional procedures.CT and MR angiography are much safer diagnosticalternatives in the detection of PPHA and fenestrations.When PPHA is detected, attention should be given tothe coexistent posterior circulation anomalies (AU)

La arteria hipoglosa primitiva persistente (AHPP) que es una anastomosis carótido-basilar persistente es una anomalía vascular rara. Se encuentra de forma incidental más frecuentemente. Las fenestraciones de arterias cerebrales son raras. Presentamos aquí un caso de AHPP con fenestración de la arteria cerebral posterior. Un varón de 28 años fue admitido en nuestrohospital por presentar mareo y pérdida transitoria devisión. El paciente fue evaluado con TC y angiografía de RM. Para nuestro conocimiento este es el primer casodescrito de una AHPP asociada a fenestración de laarteria cerebral posterior. La detección de AHPP y una anomalía vascular asociada son importantes antes de planificar tratamientos quirúrgicos o endovasculares. El CT y la angiografía en RM son formas de diagnóstico seguras ante anomalías vasculares. Cuando se detecta una AHPP se debe prestar atención a la coexistencia de nanomalías de la circulación posterior (AU)

The evaluation of the peak flow velocity and cross-sectional area of the femoral artery and vein following totally extraperitoneal vs preperitoneal open repair of inguinal hernias.

BACKGROUND: Both totally extraperitoneal (TEP) and preperitoneal (PPOR) approaches involve the placement of prosthetic material preperitoneally. As the prosthetic material overlies the femoral artery and vein, we aimed to assess its effect on the velocity and the diameter of the artery and vein, using colour Doppler ultrasonography in both approaches. METHODS: Eighty patients with unilateral groin hernia were prospectively randomised to have either TEP repair (n = 40) or PPOR (n = 40). All patients underwent colour Doppler ultrasound study 6 months after the procedure, and all patients were followed up for 5 years to evaluate real recurrence rates. RESULTS: Our study revealed that neither mean diameter nor mean flow velocity is changed by the insertion of the mesh preperitoneally. Change was only observed in the peak systolic femoral arterial blood velocity, which was significantly decreased in the PPOR group. We also found that no patient in this study developed a clinically significant deep-vein thrombosis during 6 months of follow-up. CONCLUSIONS: It is concluded that the insertion of a prosthetic mesh during TEP or PPOR does not influence the mean peak flow velocity and the cross-sectional area of the vessels in the inguinal region and can be used safely for open and laparoscopic preperitoneal approaches.

Non-penetrating deep sclerectomy in unilateral open-angle glaucoma secondary to idiopathic dilated episcleral veins.

PURPOSE: To investigate the efficacy of non-penetrating deep sclerectomy (NPDS) in a secondary open-angle glaucoma case due to dilated episcleral veins, on intraocular pressure and retrobulbar hemodynamics. METHODS: NPDS was done on a 32-year-old male unilateral open-angle glaucoma secondary to idiopathic dilated episcleral veins. RESULTS: Except for hyphema and shallow anterior chamber on the first post-operative day, no other complications were observed. Intraocular pressure was 18-20 mmHg during the first six months, without medication or visual loss. Retrobulbar color Doppler imaging showed normal mean and end-diastolic velocities and pulsatility indices of the posterior ciliary and central retinal arteries at end of the first post-operative year. CONCLUSIONS: NPDS may be an alternative to trabeculectomy in open-angle glaucoma secondary to dilated episcleral veins.

Thyroxine prophylaxis after bilateral subtotal thyroidectomy for multinodular goiter.

In this study, we investigated the value of thyroxine administration to prevent recurrence after bilateral subtotal thyroidectomy for multinodular goiter. Patients that had benign multinodular goiter were operated on with the same surgical principles: ligation of both superior and inferior thyroid arteries on both sides, bilateral subtotal resection of thyroid gland including all visible nodules. On the 3rd postoperative day, the patients were divided into two groups: with 100 microgram 1-thyroxine daily (Thyroxine group) or no therapy (Control group). No recurrences were encountered among 40 patients followed up for 6 months and 20 patients for at least one year. One patient in the control group developed manifest hypothyroidism (5.3%). The mean TSH level of the control group was significantly higher than that of thyroxine group at 1st, 2nd, 3rd, 4th, 5th, 6th, and 12th months. At the end of the first year, the mean TSH level of the control group was four times that of the normal. On the other hand, the mean TSH level of the thyroxine group was within normal limits but not suppressed. In conclusion, we found that the pituitary-thyroid axis did not become normal spontaneously one year after thyroidectomy. Therefore, postoperative thyroxine administration seems to be of value, especially in endemic regions like Turkey.

Effects of scleral buckling on the retrobulbar haemodynamic changes.

PURPOSE: This study was planned to investigate blood flow changes due to scleral buckling surgery. In addition the effects on these changes of factors related to patient characteristics and operative technique were studied. METHODS: Central retinal artery (CRA) and ophthalmic artery (OA) blood flow velocities were studied with colour Doppler ultrasonography after scleral buckling surgery in 25 patients with unilateral rhegmatogenous retinal detachment. The effects of the patient's age, referral time, aetiological factors, operative technique, cryotherapy width and buckling distance on the haemodynamic changes were noted. RESULTS: Buckling surgery reduces the blood flow velocities in the CRA, but affects OA blood flow less. Encircling is found to be responsible and it is greater in patients with anatomical success. Other factors do not have any significant effect on these changes. CONCLUSIONS: Good anatomical and functional results can be achieved despite these haemodynamic changes. It must be kept in mind that these changes may cause complications in some patients and the surgery must be minimized.

Hemodynamic changes after strabismus surgery.

AIM: The aim of this study was to investigate the hemodynamic changes that may occur in the retrobulbar circulation after strabismus surgery, using color Doppler ultrasonography (CDI). METHODS: Fifteen healthy volunteers (control group, n=15) and sixteen patients diagnosed with strabismus were enrolled in the study. Either recession or resection was planned on one horizontal rectus muscle in the eyes of Group 1 (n=11) and on two horizontal rectus muscles in the eyes of Group 2 (n=10). CDI was performed to measure peak systolic velocity (V(max)), end-diastolic velocity (V(min)) and mean blood flow velocity (V(mean)) in the ophthalmic artery (OA), central retinal artery (CRA) and posterior ciliary artery (PCA) in the control group and in Groups 1 and 2, both preoperatively and 2-7 days postoperatively. RESULTS: The postoperative resistivity indexes in Groups 1 and 2 were found to be different from those in the control group. Preoperative V(max) and postoperative V(min) and V(mean) values of the vessels in Group 2 were different from those in both Group 1 and the control group (p<0. 001). In both treatment groups, the differences between postoperative and preoperative measurements of the parameters in the OA, CRA and PCA demonstrated statistical significance (p<0.001). CONCLUSION: After strabismus surgery on the horizontal recti, there are some alterations in the retrobulbar blood flow with a significant difference between pre- and postoperative blood flow velocities after single and double rectus surgery. The clinical significance of these results needs to be determined because CDI may be a useful tool in the investigation of hemodynamic alterations after anterior segment interventions that may cause anterior segment ischemia.

Marsupialization for bilateral pararenal lymphatic cysts.

A case of bilateral pararenal lymphatic cysts associated with hypertension is described. The cysts surrounded the renal parenchyma and were located underneath the renal capsule. No vascular pathology explaining the cause of hypertension was diagnosed by radiological techniques. Hypertension improved following bilateral marsupialization.

Re-evaluation of the role of impedance plethysmography in the diagnosis of deep vein thrombosis in surgical patients.

The clinical diagnosis of deep-vein thrombosis (DVT) is nonspecific and nonsensitive. As a result invasive and non-invasive laboratory tests are needed. In order to detect the diagnostic value of impedance plethysmography (IPG), a widely used non-invasive laboratory test, a prospective clinical trial was performed to compare IPG with color Doppler-ultrasonography (CDUS) and venography. Seventy-six (41 female, 35 male) high-risk abdominal surgery patients were included in the study. IPG and CDUS were performed preoperatively. During the postoperative period IPG, CDUS and venography were carried out. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of IPG were all determined. The preoperative IPG was positive in 32 patients, being (+) in 29 patients postoperatively. On the other hand, two of the 29 postoperative IPG (+) patients had DVT diagnosed postoperatively by CDUS and venography. One of 47 IPG (-) patients had DVT diagnosed postoperatively. According to these findings, the sensitivity of IPG was 67%, specificity 63%, and PPV, NPV and accuracy were 7%, 98% and 63%, respectively. Our study showed that IPG was not a reliable non-invasive laboratory method in the diagnosis and screening of DVT of the lower extremity.