Crimean-Congo hemorrhagic fever: aid of abdominal ultrasonography in prediction of severity.

Crimean-Congo hemorrhagic fever (CCHF) is a fatal viral infection that involves multiple organs, and endothelium. We described abdominal sonographic findings of the patients infected with the Crimean-Congo hemorrhagic fever virus (CCHFV) in relation to the severity of the disease. This is a prospective study performed among hospitalized patients infected with CCHF between 2005 and 2011. A total of 210 hospitalized patients with confirmed CCHF infection were included in the study. The mean age was 47 and 49.5% of the patients were female. Patients were classified as mild, moderate, or severe disease according to their clinical and laboratory findings. The relationship between the clinical severity of CCHF and the abdominal sonographic findings was analyzed. Sonographic findings of abdomen included gallbladder wall thickening (GBWT) in 44 (21%), splenomegaly in 39 (19%), hepatomegaly in 52 (25%), decrease in echo of liver parenchyma in nine (4%), increase in echo liver parenchyma in 13 (6%), intra-abdominal fluid collection/ascites in 23 (11%), and enlarged periportal lymph nodes in seven (3%) cases. GBWT was detected in 3% of mild patients, 23% of moderate patients, and 61% of severe patients (p<0.001). In multivariate analysis to predict the severity, GBWT (odds ratio [OR] 5.4, confidence interval [CI] 1.76-16.49, p=0.003) and intra-abdominal fluid collection/ascites (OR 3.5, CI 1.07-12.61, p=0.049) were found to be significantly associated with disease severity. In conclusion, ultrasonography is a reliable, useful, and noninvasive diagnostic tool for evaluation of the abdominal findings of the patients with CCHFV infection. GBWT and intra-abdominal fluid collection/ascites were found to be predictors of severity.

Effect of port-care frequency on venous port catheter-related complications in cancer patients.

PURPOSE: Subcutaneous central venous port catheters (SCVPC) are of great importance in the treatment of patients with malignancies since they provide secure vascular access. Our aim was to assess the impact of long-term catheter care frequency on the frequency of port-related complications. PATIENTS AND METHODS: Two hundred and seven patients who had not been on active chemotherapy through their SCVPC for at least 3 months were enrolled into the study. Those who received catheter care every 3 months or more frequently were assigned to the frequent care group, and the others to the infrequent care group. The patients were examined for port-related complications and thrombosis including port occlusion. Routinely in our clinic, catheter care was done by using 300 IU of heparin. RESULTS: According to the frequency of SCVPC care, 49 (23.7 %) patients were in the frequent care group and 158 (76.3 %) were in the infrequent care group. Median follow-up of all patients was 671 days (range 133-1712). Median frequency of port care in the frequent care group was 90 days (range 30-90), but 441.5 days in the infrequent care group (range 91-1630). None of the patients experienced port-related severe complications during the follow-up time. None of them presented with port occlusion. When the groups were analysed for thrombus (symptomatic and asymptomatic), there was no statistically significant difference (6.4 vs 13.8 %, p = 0.17). Those patients who had received more than first-line chemotherapy were found to have more thrombi than the patients who were treated with only one type of chemotherapy protocol (28.6 vs 10.2 %, p = 0.01), and the patients who had metastatic disease at the last control were found out to have thrombi more frequently than the non-metastatic patients (24.3 vs 9.3 %) (p = 0.01). CONCLUSIONS: In the present study, there was no difference in port-related severe complications between frequent and infrequent care groups during follow-up. However, the rate of thrombosis was slightly higher in the infrequent port care group.

Torsion of extraperitoneally transplanted kidney: an unusual complication.

Torsion of the extraperitoneally transplanted kidney is rare complication with no clinical data in the literature. The authors present the case of a 44-year-old man with end-stage renal disease who received a kidney transplant from his father. On postoperative day 4, serum urea and creatinine levels increased and urine output decreased. Renal ultrasonography revealed the renal hilum to be rotated to the lateral pelvic border, causing mild pelvocaliectasis, and Doppler ultrasonography, the patients showed a poststenotic flow pattern. After the patient underwent urgent reoperation, all laboratory values and ultrasonography findings returned to normal. To the authors' knowledge, this is the first published case report of torsion of the extraperitoneally transplanted kidney. When posttransplant deterioration in renal function occurs, renal torsion should be considered in the differential diagnosis.

Left internal carotid artery agenesis associated with basilar and left vertebral artery aneurysm.

Agenesis of the internal carotid artery (ICA) is a rare congenital anomaly. Most of the patients are asymptomatic and it is usually discovered incidentally by computed tomography (CT) or magnetic resonance imaging (MRI). There is close association of the cranial aneurysms and subarachnoid hemorrhage with ICA agenesis. We present a case of a 61-year-old male with left ICA agenesis associated with basilar artery and left vertebral artery aneurysms. The patient complained of headaches and numbness on the right-side of the face. Physical examination showed high blood pressure (210/90 mmHg). Neurological examination revealed nystagmus and decreased sensation on the right-side of the face. Agenesis of left ICA, left carotid canal with basilar and left vertebral artery aneurysms were demonstrated incidentally using CT, MRI, and digital subtraction angiography, as a part of an evaluation for suspected cerebrovascular accident.

Femoral vessel blood flow dynamics following totally extraperitoneal vs Stoppa procedure in bilateral inguinal hernias.

BACKGROUND: Both totally extraperitoneal (TEP) and open preperitoneal (Stoppa) procedures involve the placement of prosthetic material preperitoneally. Because the prosthetic material overlies the femoral artery and vein, the aim of this study was to assess its effect on the velocities and diameters of the artery and vein using color Doppler ultrasonography in both approaches. METHODS: Sixty-four patients with bilateral groin hernias were prospectively randomized to undergo either TEP (n = 32) or Stoppa (n = 32) repair. All patients underwent color Doppler ultrasound 6 months after the procedures, and the median follow-up period was 18 months. RESULTS: Neither mean diameter nor mean flow velocity was changed by the insertion of the mesh preperitoneally. The only change was observed in peak systolic femoral arterial blood velocity, which was significantly decreased in the Stoppa group. Also, no patient in this study developed clinically significant deep venous thrombosis during 6 months of follow-up. CONCLUSIONS: The insertion of a prosthetic mesh during TEP and Stoppa procedures does not influence the mean peak flow velocities and cross-sectional areas of the vessels in the inguinal region and can be used safely for open and laparoscopic preperitoneal approaches.

Falciform ligament in the management of the residual cavity for liver hydatidosis: new surgical technique.

INTRODUCTION: Hydatid disease is a common condition worldwide and continues to be a significant societal problem in many countries of all continents. Alhough other treatment options are also available, surgery remains the cornerstone of therapy for hepatic hydatid disease. Omentoplasty seems to be an efficient technique for managing the residual cavity, but it has some shortcomings and might be difficult in secondary cases. Therefore we describe a new technique using the falciform ligament as a flap instead of omentum for managing the residual cavity, as it is more anatomic and a better option for liver cysts. METHODS: From April 2004 to October 2005, a total of 20 patients (11 women) with a median age of 43 years (range 23-66 years) underwent partial cystectomy-falciformoplasty for hydatid liver disease. The falciform ligament was prepared as a flap in all patients during the initial step of the operation and, after partial cystectomy and evacuation of the cystic components, the flap was inserted into the cystic cavity and fixed with sutures. A single drain was inserted into the subhepatic area. RESULTS: Cysts were located in the right lobe of the liver in 14 patients and mean diameter of the cyst was 10 cm (range 7-25 cm). The mean duration of the operation was 40 minutes (range 35-69 minutes), and the mean postoperative hospital stay was 4 days (range 3-7 days). None of the patients had any major complications. Only two patients had persistent drainage for 7 days, which stopped spontaneously. The median follow-up was 9 months (range 2-19 months). Patients underwent duplex ultrasonography (US) to check the viability of the flap and the residual cavity at 1 week, 1 month, and 3 months postoperatively. US did not reveal any collection, the cavities were fully collapsed, and blood flow to the falciform ligaments was seen to be viable. CONCLUSIONS: Using the falciform ligament as a flap for management of the residual cavity is an easy, safe, effective new technique with few complications. It might be a good choice in patients with hydatid liver disease.

A complication of brucellosis: epididymoorchitis.

BACKGROUND: Epididymoorchitis is the most frequent genitourinary complication of brucellosis. METHODS: This prospective study was conducted between February 2001 and January 2004, prospectively. Male patients diagnosed with brucellosis were included in this study and evaluated for testicular involvement. RESULTS: Epididymoorchitis was detected in 17 out of 134 (12.7%) male patients with brucellosis. Mean age of the patients was 36.9+/-7.1 years. Twelve patients (70.6%) had acute, four patients (23.5%) had subacute, and one patient (5.9%) had chronic brucellosis. The most common symptoms were scrotal pain (94%) and swelling (82%). Eleven patients had unilateral epididymoorchitis, four had unilateral orchitis and two had unilateral epididymitis. A testicular abscess was detected in one patient. Sperm analysis was performed on 14 patients. Five patients had aspermia and eight had oligospermia. Combined antibiotic therapy was started and continued for 6-8 weeks. Orchiectomy was required for two patients and granulomatous orchitis was detected in the resected specimens. Relapse occurred in only one patient. Three patients had permanent oligospermia and one patient had permanent aspermia after the antibiotic therapy. Younger age, high C-reactive protein level and blood culture positivity were statistically significant differences between the patients with and without epididymoorchitis. CONCLUSIONS: Brucellosis should be considered in the diagnosis of scrotal diseases in endemic areas. A conservative approach is usually adequate for managing brucellar epididymoorchitis. However, infertility problems may develop in these patients. Well-designed further investigations are needed to explain the relationship between brucellar epididymoorchitis and infertility in man.

Effects of hypertension and antihypertensive treatment on retrobulbar circulation detected on Doppler sonography.

OBJECTIVE: To study the effect of antihypertensive drugs in essential hypertension and in the central retinal, posterior ciliary, and ophthalmic arteries by using Doppler sonography. METHODS: Thirty patients with essential hypertension and 32 control subjects were enrolled in the study. The pulsatility and resistive indices were evaluated in the central retinal, posterior ciliary, and ophthalmic arteries before and 2 months after treatment with antihypertensive drugs as well as in the control group. The pulsatility and resistive index values for each artery in each group were compared statistically. RESULTS: There were significant differences in the retrobulbar pulsatility and resistive index values in each artery among the patients with initially diagnosed hypertension and the control group (P < .05). There were significant reductions in the resistive and pulsatility index values of the posterior ciliary and ophthalmic arteries after treatment (P < .05). For the ophthalmic artery, posttreatment pulsatility and resistive index values did not reach the level of flow measured in the control subjects. CONCLUSIONS: The alteration of Doppler parameters of medication-free patients with hypertension may result from a peripheral vasospasm in the retrobulbar circulation, and the improvement in the Doppler parameters with oral antihypertensive drugs may indicate the importance of early diagnosis in ameliorating hypertension-induced retrobulbar circulation changes.

Staging laparoscopy for gastric cancer.

Surgical resection remains the only potentially curative treatment of patients with gastric cancer. Evaluation of surgery and other treatments depends on accurate staging of the disease. The objective of the study was to compare staging laparoscopy with ultrasonography, endoscopic ultrasound, computed tomography, and histology for serosal infiltration, lymph node metastasis, peritoneal seeding, and hepatic metastasis. Diagnostic laparoscopy was carried out in 48 patients. Prelaparoscopic staging in all cases included upper gastrointestinal endoscopy and biopsies followed by endosonography, ultrasound, and computed tomography. Preoperative combined examination using CT and laparoscopy was superior when compared with each modality alone or the combinations of the other tests. The present study showed that preoperative evaluation of patients with laparoscopy is superior to all other diagnostic tests. We also found that laparoscopy and computed tomography were better in accurately assessing the serosal infiltration, peritoneal seeding, and hepatic metastases, which thus allows the surgeon to choose more effective treatment modality.