Diagnostic and Therapeutic Value of ERCP in Acute Cholangitis

Cholangitis, with a clinical spectrum between acute ascending cholangitis and acute fulminant cholangitis, the mildest and the most severe forms, respectively, is the infection of bile ducts with a potential of serious mortality and morbidity. Obstruction of the bile ducts followed by infection, withE. colibeing the most commonly isolated agent, is common to all forms of cholangitis. Biliary obstruction is caused by choledocholithiasis mostly. “Choledochal pressure” is the most important factor, determining morbidity. If the pressure exceeds 25 cm H2O, which is the critical value, immune dysfunction ensues. Sepsis is common if the infection of biliary ducts is suppurative. Mortality and morbidity are inevitable if left untreated or drained late. The objective of this study is, in the stand point of the current literature, to analyse the diagnostic, therapeutic success and complication rates of ERCP (Endoscopic retrograde cholangiopancreatography) in patients with a diagnosis of acute purulent cholangitis with no response to medical treatment.</jats:p

Renal and suprarenal insufficiency secondary to familial Mediterranean fever associated with amyloidosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Familial Mediterranean fever is an autosomal recessive disease that predominantly affects people of the Mediterranean coast. One of the most frequent complications of the disease is amyloidosis. This clinical entity is known as secondary (also called AA) amyloidosis.</p> <p>Case presentation</p> <p>In this report, we describe the case of a 33-year-old Turkish man with familial Mediterranean fever and chronic renal insufficiency. He was admitted to our clinic with symptoms of suprarenal insufficiency. The patient died three months later as a result of cardiac arrest.</p> <p>Conclusion</p> <p>Our aim is to make a contribution to the literature by reporting a case of combined insufficiency due to the accumulation of renal and adrenal amyloid in a patient with familial Mediterranean fever, which has very rarely been described in the literature. We hope that adrenal insufficiency, which becomes fatal if not diagnosed and treated rapidly, will come to mind as easily as chronic renal failure in clinical practice.</p

Steinert's syndrome presenting as anal incontinence: a case report

<p>Abstract</p> <p>Introduction</p> <p>Myotonic dystrophy (MD) or Steinert's syndrome is a rare cause of chronic diarrhea and anal incontinence. In the presence of chronic diarrhea and fecal incontinence with muscle weakness, neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis.</p> <p>Case Presentation</p> <p>We present the case of a 45-year-old Turkish man with Steinert's syndrome, who was not diagnosed until the age of 45.</p> <p>Conclusions</p> <p>In clinical practice, the persistence of diarrhea and fecal incontinence with muscle weakness should suggest that the physician perform an anal manometric study and electromyography. Neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis.</p

Thyroid Anatomy and Anatomical Complications of Thyroid Surgery [tiroid Anatomisi Ve Tiroid Cerrahisinin Anatomik Komplikasyonlari]

The thyroid gland is important and highly vascular endocrine gland, consists of right and left lobes. It is located anterior to the second and third tracheal cartilages. Usually there are two parathyroid glands on each side of the thyroid gland, but the total number varies between two and six. The arteries to the thyroid gland are the palred superior and inferior thyroid artery. The veins from the thyroid gland are the superior thyroid and the middle thyroid and the inferior thyroid arteries. The gland receives its innervation from sympathetic and parasympathetic divisions of the autonomic nervous system. The parasympathetic fibers are derived from the vagus and reach the gland via branches of the laryngeal nerves. The thyroid gland's relation to the recurrent laryngeal nerve and to the external branch of the superior laryngeal nerve is of major surgical significance since damage to these nerves leads to a disability of phonation. Damage to this nerve leads to vocal cord paralysis on the same side. It is very important for the surgeon to carefully identify this nerve at the time of operation. Surgeons attempting operations on the thyroid gland must be well Informed on the anatomy of the neck, including the thyroid gland, its blood supply and its nerve supply, as well as its adjacent structures; the trachea, the larynx, the esophagus, and the parathyroid glands. Surgical treatment of the thyroid is performed to establish the diagnosis in a patient with a mass within the thyroid gland, to remove benign and malignant tumors, as therapy for thyrotoxicosis and to alleviate pressure symptoms attributable to the thyroid. The morbidity is about 13 percent when all complications, including those the most minor types, are considered. Four major complications classically have been associated with thyroidectomy

Sarcoidosis Incidentally Diagnosed: A Case Report

Sarcoidosis is a chronic, granulomatous condition with unknown cause. Because most of the patients are free of clinical symptoms, sarcoidosis should be considered in differential diagnosis if noncaseous granuloma is noted in biopsies, performed for other reasons. With no clinical symptoms, our patient was diagnosed with sarcoidosis upon identifying noncaseous granuloma in the lymph node biopsy material collected during the laparoscopic operation, performed for gallbladder polyp