Child with Pancreatic Hydatid Cyst Presenting with Cholestasis.

Although hydatid cysts are often seen in the liver and lungs, they may be present in many organs. Even in countries where hydatid cyst disease is endemic, the occurrence of pancreatic hydatid cysts is rare. Pancreatic hydatid cysts are important for the differential diagnosis of patients with pancreatic pseudocysts and cystic carcinomas. We could not find cystic echinococcosis cases which are kept together pancreas and liver in PubMed. In this article, we highlight the fact that pancreatic cystic echinococcosis may play a role in the etiology of cholestasis and that cysts may not be isolated in the pancreas in a pediatric population.

Cystic Eechinococcosis in Childhood: Five-Years of Experience From a Single-Center.

OBJECTIVE: To evaluate the clinical data and prognosis of cystic echinococcosis during a 5-year period who were followed by the pediatric clinics. METHODS: Demographic, clinical, laboratory, and prognosis data of 34 patients with cystic echinococcosis obtained between 2009 to 2014 were retrospectively evaluated. Of these, 10 patients were excluded because of incomplete data or failure to follow up. RESULTS: A total of 24 (12 males and 12 females) children were included the study. The mean ages of patients were 11.17 ± 3.71 (range, 5-17) years. The most common symptoms were abdominal pain (41.7%), cough (16.7%), and fatigue (12.5%). Localization of the parasite in the patients was determined to be as follows: liver (54.2%), lung (33.3%), and intraabdominal (4.2%). Multiorgan involvement was observed in 8.3% of the cases. Indirect hemagglutination test was positive in 13 (54.2%) patients at admission. All patients received treatment with albendazole. Seven patients were treated with puncture-aspiration-injection-re-aspiration (PAIR) (29.2%). Open surgery was performed in six patients (24.2%). One patient was treated with both PAIR and open surgery. CONCLUSIONS: Cystic echinococcosis is a serious public health problem in developing countries. Hydatid cyst should be considered in the presence of suspicious radiological and clinical findings in endemic areas.

Investigation of X-ray permeability of surgical gloves coated with different contrast agents.

OBJECTIVE: We aimed to investigate the effectiveness and radiation protection capability of latex gloves coated with various contrast agents as an alternative to lead gloves. METHODS: The following six groups were created to evaluate the permeability of X-ray in this experimental study: lead gloves, two different non-ionic contrast media (iopromide 370/100 mg I/mL and iomeprol 400/100 mg I/mL), 10% povidone-iodine (PV-I), 240/240 g/mL barium sulphate and a mixture of equal amounts of all contrast agents. A radiation dose detector was placed in coated latex gloves for each one. The absorption values of radiation from latex gloves coated with various contrast agents were measured and compared with the absorption of radiation from lead gloves. This study was designed as an 'experimental study'. RESULTS: The mean absorption value of X-ray from lead gloves was 3.0±0.08 µG/s. The mean absorption values of X-ray from latex gloves coated with various contrast agents were 3.7±0.09 µG/s (iopromide 370/100 mg I/mL), 3.6±0.09 µG/s (iomeprol 400/100 mg I/mL), 3.7±0.04 µG/s (PV-I), 3.1±0.07 µG/s (barium sulphate) and 3.8±0.05 µG/s (mixture of all contrast agents). Latex gloves coated with barium sulphate provided the best radiation absorption compared with latex gloves coated with other radiodense contrast agents. CONCLUSION: Latex gloves coated with barium sulphate may provide protection equivalent to lead gloves.

Secondary ablation of saphenous veins: The reasons and the ratios.

OBJECTIVE: To assess recurrence of saphenous veins and their tributaries following endovenous laser ablation (EVLA) and define primary or secondary ablation ratios as a result of misinterpretation, new incompetency formation, and re-canalization. METHODS: The EVLA procedure was applied for vein insufficiency to 50 symptomatic patients (range, 22-78 years; mean age 45 ± 14 years; gender, 18 [36%] men, and 32 [64%] women). Before and after the procedure, a total of 80 legs were prospectively evaluated for recanalization of the great and small saphenous vein, anterolateral, posteromedial, intersaphenous thigh, and the calf veins by Doppler ultrasonography. EVLA was performed on the saphenous veins along with their tributaries, and was defined as the primary ablation. EVLA and alcohol ablation after the first procedure was defined as the secondary ablation. We evaluated the veins according to re-canalization and secondary ablation, and also measured the primary and secondary ablation ratios. RESULTS: Seventy-three (97.0%) VSM and 39 (95.0%) VSP were treated with primary ablation and 2(3.0%) VSM and 2 (5.0%) VSP were treated with secondary ablation because of newly developed incompetency. In addition, 15 (71.0%) saphenous tributaries were treated with primary and 6 (29.0%) with secondary ablation. After primary or secondary ablation, 9 (12.0%) misinterpretation or new incompetency formation was found during a one-year follow-up. Seven (9.0%) VSM were re-canalized at the mean length of 46 ± 15 cm (range 32-65 cm) in one year. The laser energy in the re-canalized VSM was 78 ± 25 joules/cm (range 61-83) and all were retreated with laser or foam sclerotherapy. CONCLUSIONS: VSM re-canalization and new vessel incompetency formation are reasons for secondary ablation, which is not a rare condition. Follow-up examinations and anatomical mapping are crucial for detecting new vessel formation or miss-interpretation after sclerotherapy or EVLA treatment.

Transthoracic biopsy of lung masses: Non technical factors affecting complication occurrence.

BACKGROUND: To investigate the transthoracic computed tomography (CT)-guided lung nodule biopsy complications and risk factors associated with the development of these complications. METHODS: We retrospectively evaluated a total of 41 CT-guided transthoracic biopsy complications. Data was analyzed by chi-square and independent sample t-tests. RESULTS: Twenty-seven patients (28.7%) developed pneumothorax and eight patients (8.5%) developed parenchymal hemorrhage, and four patients (4.3%) hemothorax and two (2.1%) patients developed subcutaneous emphysema. A significant correlation was obtained between the development of pneumothorax and lesion size (P = 0.040), and the distance that traversed the parenchyma (P = 0.001). There was a statistically significant difference between the parenchymal hemorrhage and lesion size and the distance from passed parenchyma (P values were 0.021 and 0.008, respectively). An increased incidence of parenchymal hemorrhage and pneumothorax was observed at small size and deep-seated lesions. CONCLUSION: Lesion size and the distance that traversed the parenchyma on the biopsy tract are the most important factors that influence the development of complications in CT-guided transthoracic biopsy.

Comparing 1470- and 980-nm diode lasers for endovenous ablation treatments.

The purpose of this study was to compare the effectiveness of 1470- and 980-nm lasers with regard to power output, complications, recanalization rates, and treatment response. We prospectively evaluated the effectiveness of endovenous laser ablation (EVLA) in a total of 152 great and small saphenous veins from 96 patients. Lasers were randomly used based on the availability of the units. Patients were clinically evaluated for Clinical Etiologic Anatomic Pathophysiologic (CEAP) stage and examined with Doppler ultrasound. Treatment response was determined anatomically by occlusion of the vein and clinically by the change in the venous clinical severity score (VCSS). Seventy-eight of the saphenous veins underwent EVLA with a 980-nm laser and 74 underwent EVLA with a 1470-nm laser. Treatment response was (68) 87.2 % in the 980-nm group and (74) 100 % in the 1470-nm group (p = 0.004). The median VCSS decreased from 4 to 2 in the 980-nm group (p < 0.001) and from 8 to 2 (p < 0.001) in the 1470-nm group. At 1-year follow-up, seven veins treated with 980 nm and two veins treated with 1470 nm were recanalized (p = 0.16); the average linear endovenous energy density (LEED) was 83.9 (r, 55-100) J/cm and 58.5 (r, 45-115) J/cm, respectively (p < 0.001). Postoperative minor complications occurred in 23 (29.4 %) limbs in the 980-nm group and in 19 (25.6 %) limbs of the 1470-nm group (p = 0.73). EVLA with the 1470-nm laser have less energy deposition for occlusion and better treatment response.

CT-guided transthoracic biopsy: histopathologic results and complication rates.

PURPOSE: We aimed to investigate the effectiveness and complications of transthoracic CT-guided biopsy techniques. METHODS: A total of 94 CT-guided percutaneous transthoracic biopsy procedures performed in 85 patients were retrospectively evaluated. Core biopsy technique was used in 87 procedures and transthoracic fine-needle aspiration biopsy was used in seven procedures. RESULTS: Diagnostic results were achieved in 79 of 94 biopsy procedures. Pathology results were malignant in 54 patients, suspicious for malignancy in three patients, benign in five patients, and benign nonspecific in 17 patients. Specific diagnoses were obtained in 59 patients (62.8%) using core biopsy, but no specific diagnosis could be reached with transthoracic fine-needle aspiration biopsy. Complications included pneumothorax in 27 patients (28.7%) and parenchymal hemorrhage during and after the procedure in eight patients (8.5%). CONCLUSIONS: CT-guided percutaneous transthoracic needle biopsy is a highly accurate procedure for histopathological diagnosis of thoracic masses. In addition, percutaneous transthoracic biopsy has an acceptably low complication rate and it reduces the need for more invasive surgical procedures.

Anti TNF-α therapy might be responsible for an increased incidence of varicocele in patients with ankylosing spondylitis.

AIM: To evaluate the effects of anti-tumor necrosis factor-alpha (TNF-α) therapy on the frequency of varicocele in patients with ankylosing spondylitis (AS) using color Doppler ultrasound. MATERIALS AND METHODS: The patients were divided into 2 groups: patients with AS who were on anti-TNF-α treatment and patients with AS who were not regularly taking any antiinflammatory drugs. Thirty-one healthy volunteers were included as controls. RESULTS: Left-sided varicocele was determined in 14 patients of Group 1 (44%), 10 patients of Group 2 (33%), and 7 of the controls (23%). There was a statistically significant difference only between Group 1 and controls (P = 0.009). However, right-sided varicocele was determined in 12 patients of Group 1 (38%), 2 patients of Group 2 (6%), and 2 of the controls (6%) (P = 0.01 vs. Group 2, P = 0.005 vs. controls). CONCLUSION: The present study shows that patients with AS who were taking anti-TNF-a therapy had an increased prevalence of right- sided and bilateral varicocele compared to patients with AS who were not taking any disease-modifying antirheumatic drugs and the healthy control group.

Choledochoduodenal fistula: An unusual cause of recurrent cholangitis in children.

Choledochoduodenal fistula (CDF) is an unusual clinical entity and a diagnostic challenge in children. We herein present CDF as an unusual cause of recurrent cholangitis in a 6-year-old child. To the best of our knowledge, this is the youngest patient reported until date. In this paper, we also highlight possible etiologic factors, presenting symptoms, diagnostic methods, and treatment modalities of CDF.

Diagnostic quality of CT pulmonary angiography in pulmonary thromboembolism: a comparison of three different kV values.

BACKGROUND: Our purpose was to evaluate the effectiveness of different kilovolt (kV) uses in computed tomography pulmonary angiography (CTPA) in the diagnosis of pulmonary thromboembolism (PTE). We also aimed to establish the optimal kV value and investigate the possibility of obtaining appropriate imaging quality with minimal radiation dose. MATERIAL AND METHODS: We compared 120, 100, and 80 kV CTPA for 90 patients in whom PTE was clinically considered. The examinations were carried out using a 128 multislice CT device (Definition AS, Siemens Medical Solutions, Forchheim, Germany). Each kV value was used on 30 patients in 3 groups. Patients in all groups were compared with respect to the mean radiation dose they received, pulmonary arterial attenuation values, image quality, and motion artefacts. RESULTS: With respect to pulmonary arterial attenuation values, imaging with 80 kV yielded significantly higher values (p<0.05). However, no difference was found between 120 kV, 100 kV, and 80 kV with respect to image quality. Similarly, no significant difference was detected between the groups with respect to pulmonary artery contrasting and motion artefacts. Statistically significant differences were present in DLP values and effective dose among all 3 groups (p<0.001). CONCLUSIONS: Using 80 kV as the low value in CTPA imaging for patients pre-diagnosed with PTE will increase the density of pulmonary arteries and decrease the amount of radiation received.

Early diagnostic clues in neonatal chronic gastric volvulus.

PURPOSE: Neonatal gastric volvulus (GV) is a rare clinical entity with a challenging diagnosis. In this study, we aimed to identify clinical and radiological findings to aid in early diagnosis in neonatal GV. MATERIALS AND METHODS: The medical records of all neonates with GV were retrospectively reviewed. Diagnosis was made based on clinical findings and radiological images, and was documented by an upper gastrointestinal (UGI) contrast study. RESULTS: A total of eight neonates were included in the study. The most common clinical presentations were non-bilious vomiting and epigastric distention. The findings highly suggestive for GV in plain radiographs include gastric double bubble, abnormal gastric distention despite a nasogastric tube, distended stomach lying in a horizontal plane and an air-fluid level in the epigastrium. CONCLUSION: GV should be suspected in any newborn with non-bilious vomiting and epigastric distention. It is also important to focus on the clues in the plain radiographs. Gastric double bubble, abnormal gastric distention despite a nasogastric tube, distended stomach lying in a horizontal plane and an air-fluid level in the epigastrium must alert the physicians to the possibility of GV.

Carotid CT-angiography: low versus standard volume contrast media and low kV protocol for 128-slice MDCT.

Availability and utilization of computed tomography angiography has been increasing recently. We aimed to assess the effectiveness of low amount of contrast media and low kV value in order to reduce possible side effects of contrast media and to provide optimization of kV value in the evaluation of the carotid artery with multi-detector computed tomography angiography. Forty one patients were randomized into two groups. Contrast media was administered at a dose of 1 ml/kg in group A patients and of 0.5 ml/kg in group B patients. kV value of 120 in group A and 100 in group B were chosen. Bolus tracking technique was used. Attenuation values of certain arterial segments were measured, and values over 200 HU were considered as significant. North American Symptomatic Carotid Endartherectomy Trial criteria were utilized in the evaluation of stenosis. Image quality in arterial segments of all cases was found to be sufficient for diagnosis. Arterial attenuation values were found to be higher in group B than group A. When compared separately in all arterial segments, there was no statistically significant difference between the groups. For stenosis, 615 arterial segments were evaluated. Moderate stenosis in eight segments and severe stenosis in three segments were identified in group A. Occlusion in three segments, severe stenosis in three segments, and moderate stenosis in 25 segments were detected in group B. Better image quality can be obtained, and the amount of contrast media can be reduced using low kV technique in carotid artery multi-detector computed tomography angiography examination.

Endovenous laser ablation and foam sclerotherapy for varicose veins: does the presence of perforating vein insufficiency affect the treatment outcome?

BACKGROUND: Superficial venous insufficiency is a common problem associated with varicose veins. Endovenous laser ablation (EVLA) and concomitant ultrasound (US)-guided foam sclerotherapy are recent treatment methods alternative to surgery in the treatment of superficial venous insufficiency. PURPOSE: To compare the effectiveness of EVLA and concomitant US-guided foam sclerotherapy prospectively in two different subgroups of the disease (isolated truncal vs. truncal with perforating vein insufficiency). MATERIAL AND METHODS: The study was approved by the institutional review board. Fifty-five patients with symptomatic saphenous vein insufficiency and varicose veins were included in the study. Seventy-three EVLA and concomitant foam sclerotherapy were performed for 60 lower extremities. To determine the severity of the venous disease, Venous Clinical Severity Score (VCSS) and Visual Analogue Scale (VAS) were carried out before and 6 months after the treatment. Patients were followed up clinically and with Doppler ultrasonography for 6 months after the procedures. RESULTS: At the sixth month of the follow-up; the total occlusion rate for the saphenous veins was 98.64% (72/73), and re-canalization rate was 1.36% (1/73). The total occlusion rate for the perforating veins was 75% (18/24), re-canalization rate was 25% (6/24). There was no notable major complication. VCSS and VAS scores were decreased significantly following the treatment (p < 0.05). The patients who had isolated saphenous vein insufficiency (Group I: 36/60) and those who had saphenous and perforating vein reflux (Group II: 24/60) were compared. VAS scores were more prominently decreased after the treatment in the isolated saphenous vein insufficiency group (p < 0.05). VCSS were also decreased more prominently in Group I when compared to Group II. CONCLUSION: EVLA and concomitant US-guided foam sclerotherapy are effective, safe, and minimally invasive treatment options, yielding good cosmetic and clinical results in both isolated truncal and truncal with perforating vein insufficiency groups. However, clinical results and satisfaction of the patients were remarkably superior in cases with isolated truncal vein insufficiency compared to truncal and perforating vein insufficiency.