Multiple Perforations along the Transverse Colon as a Rare Presentation of Intestinal Behcet’s Disease: A Case Report

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Fournier's Gangrene after Open Hemorrhoidectomy without a Predisposing Factor: Report of a Case and Review of the Literature

Fournier's gangrene (FG) is a fatal synergistic infectious disease with necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in men and vulva in women. An unpredictable case of FG two weeks after open hemorrhoidectomy in a previously healthy 55-year-old male is described. Full-thickness patchy skin necrosis of the perianal, perineal and scrotal region associated with rectal perforation was detected on admission. Prompt radical debridement together with aggressive fluid resuscitation and broad-spectrum antibiotic administration was initiated. Because of rectal involvement, diverting sigmoid colostomy was fashioned. The patient survived after two additional local debridements. Nevertheless, loss of sphincter function due to massive muscle destruction led to permanent colostomy. Our case together with others reported in the literature illustrates that, although rare, FG after open hemorrhoidectomy represents a life-threatening complication to otherwise healthy patients. The development of fever and urinary retention should draw the attention of the surgeon, even if the presentation is delayed. The current literature only briefly mentions the potential risk of FG after such a common surgical procedure. However, devastating complications occur more often than anticipated. This disastrous complication without predisposing factor is discussed along with a literature review

The relationship between Chlamydophila pneumoniae IgG titer and coronary atherosclerosis

Background: The role of Chlamydophila pneumoniae (CP) in the progression of atherosclerosis is controversial. Also no sufficient angiographic study is available about the impact of CP infection on severity and intensity of coronary atherosclerosis. We investigated the relation between CP IgG antibody titers and severity and intensity of coronary atherosclerosis Methods: The study population consisted of 516 consecutive patients who underwent a coronary angiography. The group included 353 patients who had coronary artery disease; a control group included 163 subjects with angiographically proven normal coronary arteries. Chlamydophila pneumoniae IgG antibody titers were measured by an enzyme immunoassay method in all patients. Gensini scores and extent scores were used to evaluate the angiographic extent and severity of atherosclerosis. Results: The mean value of IgG antibody titer was 44.3 &#177; 28.8 IU/mL in the patients and 39.8 &#177; 27.4 IU/mL in the control group (p = 0.14). There was no statistically significant correlation between the Gensini scores, extent scores and CP IgG titers (Gensini score: r = +0.103, p = 0.07, extent score: r = +0.110, p = 0.31). When we grouped the patients as high (> 50 IU/mL) and low (< 50 IU/mL) IgG antibody titers, the number of diseased coronary arteries was higher in patients with high IgG antibody titers (respectively: 2.6 &#177; 1.1 vs. 2.2 &#177; 0.8, p = 0.01). While the Gensini score was significantly higher in patients with high IgG antibody titers (7.5 &#177; 4.0 vs. 6.17 &#177; 4.0, p = 0.01), the extent score did not change with IgG titers (29.8 &#177; 15.9 vs. 25.8 &#177; 15.4, p = 0.08). Conclusions: In our study, we investigated the relation between CP infection and coronary atherosclerosis and found that CP IgG antibody titers are associated with the severity of coronary stenosis at higher antibody levels. However, there is no association between CP antibody titers and clinical presentation of coronary artery disease. We suggest that CP has limited effect on coronary atherosclerosis. (Cardiol J 2008; 15: 245-251

Temperature Effects Explain Continental Scale Distribution of Cyanobacterial Toxins

Insight into how environmental change determines the production and distribution of cyanobacterial toxins is necessary for risk assessment. Management guidelines currently focus on hepatotoxins (microcystins). Increasing attention is given to other classes, such as neurotoxins (e.g., anatoxin-a) and cytotoxins (e.g., cylindrospermopsin) due to their potency. Most studies examine the relationship between individual toxin variants and environmental factors, such as nutrients, temperature and light. In summer 2015, we collected samples across Europe to investigate the effect of nutrient and temperature gradients on the variability of toxin production at a continental scale. Direct and indirect effects of temperature were the main drivers of the spatial distribution in the toxins produced by the cyanobacterial community, the toxin concentrations and toxin quota. Generalized linear models showed that a Toxin Diversity Index (TDI) increased with latitude, while it decreased with water stability. Increases in TDI were explained through a significant increase in toxin variants such as MC-YR, anatoxin and cylindrospermopsin, accompanied by a decreasing presence of MC-LR. While global warming continues, the direct and indirect effects of increased lake temperatures will drive changes in the distribution of cyanobacterial toxins in Europe, potentially promoting selection of a few highly toxic species or strains.Peer reviewe

Data Descriptor : A European Multi Lake Survey dataset of environmental variables, phytoplankton pigments and cyanotoxins

Under ongoing climate change and increasing anthropogenic activity, which continuously challenge ecosystem resilience, an in-depth understanding of ecological processes is urgently needed. Lakes, as providers of numerous ecosystem services, face multiple stressors that threaten their functioning. Harmful cyanobacterial blooms are a persistent problem resulting from nutrient pollution and climate-change induced stressors, like poor transparency, increased water temperature and enhanced stratification. Consistency in data collection and analysis methods is necessary to achieve fully comparable datasets and for statistical validity, avoiding issues linked to disparate data sources. The European Multi Lake Survey (EMLS) in summer 2015 was an initiative among scientists from 27 countries to collect and analyse lake physical, chemical and biological variables in a fully standardized manner. This database includes in-situ lake variables along with nutrient, pigment and cyanotoxin data of 369 lakes in Europe, which were centrally analysed in dedicated laboratories. Publishing the EMLS methods and dataset might inspire similar initiatives to study across large geographic areas that will contribute to better understanding lake responses in a changing environment.Peer reviewe

Spontaneous rupture of a hepatic hydatıd cyst into the peritoneum causing only mild abdominal pain: A case report

Hydatid disease is an endemic disease in certain areas of the world. It is located mostly in the liver. Spontaneous rupture of the hydatid cyst into the peritoneum is a rare condition, which is accompanied by serious morbidity and mortality generally. We present herein a case with a spontaneous rupture of a hepatic hidatid disease into the peritoneum without any serious symptoms. A 15-year-old boy was admitted to the emergency room with a mild abdominal pain lasting for a day. Physical examination revealed only mild abdominal tenderness. There was no history of trauma or complaints related to hydatid diseases. Ultrasonography showed a large amount of free fluid and a cystic lesion with irregular borders in the liver. He was operated on. Postoperative albendazol therapy was given for 2 mo. No recurrence or secondary hydatidosis was seen on CT investigation in the 3rd, 6th and 12th mo following surgery. © 2007 The WJG Press. All rights reserved

Primary hydatid cyst disease of the spleen; a rare entity: Report of two cases

5th National Trauma and Emergency Congress -- NOV 16-20, 2005 -- Antalya, TURKEYWOS: 000257677100015Hydatid cyst disease mostly involves the liver and the lung. The spleen is one of the rare sites involved in hydatid cyst disease. The clinical presentation of the splenic hydatid cyst disease is often vague. Two cases of hydatidosis with isolated spleen involvement which were treated surgically are reported. The two patients who presented with mild abdominal discomfort, swelling, being full up quickly, were diagnosed as primary splenic hydatid cyst by ultrasonography and CT scans. Both of the patients underwent splenectomy, partial diaphragm resection and left tube thoracostomy. Both of them followed an uneventful early postoperative course and discharged from the hospital on the 6th and 18th days following the operation, respectively. One of the patients died at his home four days after his discharge, the other is under control for 24 months without an event

Divertikül içinde yerleşik papillada endoskopik klip yardımıyla safra yolu kanülasyonu

Papilla bölgesinde duodenal divertikül olan hastalarda safra yollarının endoskopik kanülasyonu çok zor olabilmektedir. Yetmiş yaşında bir bayan hasta akut kolanjit ve koledokolithiazis tanılarıyla hastanemize başvurdu. Hastaya sıvı resüsitasyonu ve antibiyotik tedavisi başlandı. Endoskopik retrograd kolanjiyopankreatografide duodenal divertikül nedeniyle safra yolları kanüle edilemedi. Farklı girişimlere rağmen safra yolları kanüle edilemedi. Endoskopik klip yardımıyla divertikülden kısmen everte edilen papilla fikse edildi. Papillanın sabitlenmesi safra yollarının direkt kanulasyonuna imkan sağladı. Kolanjiografide koledokta multiple kalkül izlendi. Sfinkterotomi, safra yollarından taş ekstraksiyonu yapılan hasta Endoskopik retrograd kolanjiyopankreatografiyi takip eden 9. gün iyi durumda taburcu edildi. Bu yazıda, özellikle büyük periampullar divertikül nedeniyle kanülasyonu çok zor olan olgularda, pankreas ve safra yollarının kanülasyonunda etkili ve güvenli bir yöntem olan endoskopik klip yardımıyla safra yolları kanülasyonu yöntemini hatırlatmak istedik.Endoscopic cannulation of the biliary tract may be challenging in cases with juxtapapillary, duodenal diverticula. A 70-yearold woman admitted to the hospital with the diagnosis of choledocholithiasis and acute cholangitis. She was placed on antibiotic treatment and parenteral fluid resuscitation. On endoscopic retrograde cholangiopancreatography, the papilla could not be cannulated because of the duodenal diverticulum. Various attempts at biliary cannulation failed. Endoscopic clips were used for evertion and fixation of a partially everted papilla from the diverticulum and for securing it in an orientation that allowed direct cannulation of the biliary tree. Cholangiography demonstrated multiple calculi within the choledochus. She was discharged from the hospital on the 9th day following endoscopic retrograde cholangiopancreatography in good condition. With this report, we aimed to remind physicians that the clipassisted method is a safe and effective technique for pancreatic and/or biliary cannulation, and should be preferred in patients in whom cannulation is extremely difficult due to large periampullary diverticula