An unexpected cause of small bowel obstruction in an adult patient: Midgut volvulus

The most important complication of intestinal malrotation is midgut volvulus because it may lead to intestinal ischaemia and necrosis. A 29-year-old male patient was admitted to the emergency department with abdominal pain. Ultrasonography (US), colour Doppler ultrasonography (CDUS), CT and barium studies were carried out. On US and CDUS, twisting of intestinal segments around the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) and alteration of the SMA-SMV relationship were detected. CT demonstrated that the small intestine was making a rotation around the SMA and SMV, which amounted to more than 360°. The upper gastrointestinal barium series revealed a corkscrew appearance of the duodenum and proximal jejunum, which is a pathognomonic finding of midgut volvulus. Prior knowledge of characteristic imaging findings of midgut volvulus is essential in order to reach proper diagnosis and establish proper treatment before the development of intestinal ischaemia and necrosis. Copyright 2014 BMJ Publishing Group. All rights reserved

Renal arter stenozu tanısında 3 boyutlu MR anjiografik inceleme

TEZ5155Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2004.Kaynakça (s. 50-53) var.vi, 53 s. ; res. ; 30 cm.

Early diagnosis of hip joint ınvolvement of ankylosing spondylitis using magnetic resonance ımaging in the absence of clinical and X-Ray findings

Objectives: This study aims to describe magnetic resonance imaging (MRI) findings of hip joint involvement in ankylosing spondylitis (AS) in the absence of clinical and X-ray signs. Patients and methods: Between January 2012 and June 2012, 23 patients with AS without hip pain symptoms who were admitted to Adana Training and Research Hospital, Department of Physical Therapy and Rheumatology were included in the study. The control group consisted of 20 healthy individuals. All patients underwent MRI examination of both hips. Results: Of 23 patients, 10 (43.4%) had a pathological finding in at least one of the two sides based on the MRI findings. Seven patients demonstrated unilateral, and three patients demonstrated asymmetrically bilateral involvements. Bone marrow edema was present in six out of the 46 hip joints (13%). Eleven hip joints (24%) showed synovial fluid. One patient had bone marrow edema together with a subchondral cyst, while another patient demonstrated a combination of bone marrow edema and tendinitis. Conclusion: There may be hip joint involvement in AS patients even in the absence of clinical and X-ray signs. Early detection of bony abnormalities may prevent both the damage to the bone and the development of ankylosis.Objectives: This study aims to describe magnetic resonance imaging (MRI) findings of hip joint involvement in ankylosing spondylitis (AS) in the absence of clinical and X-ray signs. Patients and methods: Between January 2012 and June 2012, 23 patients with AS without hip pain symptoms who were admitted to Adana Training and Research Hospital, Department of Physical Therapy and Rheumatology were included in the study. The control group consisted of 20 healthy individuals. All patients underwent MRI examination of both hips. Results: Of 23 patients, 10 (43.4%) had a pathological finding in at least one of the two sides based on the MRI findings. Seven patients demonstrated unilateral, and three patients demonstrated asymmetrically bilateral involvements. Bone marrow edema was present in six out of the 46 hip joints (13%). Eleven hip joints (24%) showed synovial fluid. One patient had bone marrow edema together with a subchondral cyst, while another patient demonstrated a combination of bone marrow edema and tendinitis. Conclusion: There may be hip joint involvement in AS patients even in the absence of clinical and X-ray signs. Early detection of bony abnormalities may prevent both the damage to the bone and the development of ankylosis

Prevalence and Characteristics of Eagle Syndrome

Bu çalışmanın amacı uzun süreli kulak ağrısı şikayeti ile gelen hastalarda Eagle sendromunun epidemiyolojisini araştırılmasıdır. Materyal ve Metod: Bu çalışma prospektif bir çalışma olup, haziran 2012 ile aralık 2012 tarihler arasında ez az 6 aydır devam eden kulak ağrısı şikayeti ile kliniğimize başvuran 48 hasta incelenmiştir. Tüm hastaların aksiyel planda maksillofasiyal BT tetkiki istenerek uzun stiloid proçesi olan olguların stiloid proçesleri ölçüldü. Stiloid çıkıntısı 30 mm'den uzun olan olgular Eagle sendromu olarak yorumlandı. Bulgular: Stiloid proçes uzunluğu 30 mm ve daha fazla olan 10 olgu (%20.8) Eagle sendromu olarak yorumlandı. Sonuç: Otalji yapabilecek primer nedenler dışlandıktan sonra Eagle sendromu, özellikle şikayetleri ile fizik muayenesi arasında uyumsuzluk gözlenen hastalarda araştırılması gereken sekonder otalji nedenlerinden biridirThe aim of this study is to determine the epidemiology of the Eagle's syndrome among patients presenting with a long-term complaint of pain in the ear. Material and Methods: In this prospective study, 48 patients with a complaint of otalgia lasting for 6 months, admitted to our clinic between June 2012 and December 2012 were included. All patients underwent to a maxillofacial CT scan, to detect the length of the styloid process. Patients with a length of more than 30 mm of styloid process were interpreted as Eagle's syndrome. Results: Ten patients(20.8%) with more than 30 mm length of styloid process were diagnosed as Eagle's syndrome. Conclusion: In patients with inconsistency in complaints and physical examination, Eagle syndrome as one of the causes of secondary otalgia, must be considered beside the primer otalgi

Ocena związku między wskaźnikiem oporu tętnic nerkowych a rozległością i złożonością choroby wieńcowej u pacjentów z ostrym zespołem wieńcowym

Background: Despite advances in cardiovascular medicine, acute coronary syndrome (ACS) is still a major cause of morbidity and mortality worldwide. Synergy between percutaneous coronary intervention with TAXUS™ and Cardiac Surgery (SYNTAX) score is used to determine the extent and complexity of coronary artery disease (CAD). Renal resistive index (RRI), a renal Doppler ultrasound parameter, is used to detect renal haemodynamics. Although some risk factors for CAD, including hypertension and diabetes mellitus, were demonstrated to have an association with RRI; a direct relationship between the presence, extent, and complexity of CAD and RRI has not been investigated yet. Aim: In this study, we evaluated the relationship between RRI and SYNTAX score in patients with ACS. Methods: This cross-sectional study enrolled 235 patients who were diagnosed with ACS and underwent coronary angiography at our tertiary clinic between February 2016 and August 2016. Regarding clinical presentation, 112 patients were diagnosed with non-ST-segment elevation ACS (NSTE-ACS) and 123 patients were diagnosed with ST-segment elevation ACS (STE-ACS). The patients’ demographic, clinical, laboratory, echocardiographic data, SYNTAX scores and measurements of renal Doppler ultrasound parameters, including RRI, renal pulsatility index (RPI) and acceleration time (AT) were recorded. Results: Among 235 patients, 112 (47.7%) were diagnosed with NSTE-ACS and 123 (52.3%) were diagnosed with STE-ACS. Mean SYNTAX score and RRI of patients with NSTE-ACS and STE-ACS were 15.4 and 0.69, 21.1 and 0.67, respectively. The SYNTAX score was associated with gender, height, plasma uric acid level, left atrial diameter, left ventricular (LV) end-systolic and end-diastolic diameter, RPI, and RRI in patients with NSTE-ACS, as well as with low-density lipoprotein-cholesterol, total cholesterol, ejection fraction, and LV end-systolic diameter in patients with STE-ACS (p < 0.05 for each variable). RRI was significantly associated with age, haemoglobin level, left atrial diameter, SYNTAX score, AT, and RPI in patients with NSTE-ACS, as well as with weight, body mass index, interventricular septum thickness at diastole, LV posterior wall thickness at diastole, LV ejection fraction, and RRI in patients with STE-ACS. Multivariate logistic regression analysis demonstrated that LV end-systolic diameter (β = 0.385, 95% CI 1.065–2.029, p = 0.019), RRI (β = 32.230, 95% CI 5343.15–2.E+24, p = 0.008), and RPI (β = –7.439, 95% CI 0.000–0.231, p = 0.015) were independent predictors of moderate to high SYNTAX score in patients with NSTE-ACS. Conclusions: Non-invasively detected RRI is closely associated with the extent and complexity of CAD in patients with NSTE-ACS. However, there is a need for randomised, controlled studies involving wider populations.  Wstęp: Mimo postępu w zakresie leczenia chorób sercowo-naczyniowych ostry zespół wieńcowy (ACS) jest nadal główną przyczyną chorób i zgonów na całym świecie. Zbieżność między przezskórną interwencją wieńcową z wszczepieniem stentu uwalniającego tacrolimus TAXUS™ a wskaźnikiem SYNTAX stosuje się do oceny rozległości i złożoności choroby wieńcowej (CAD). Wskaźnik oporu tętnic nerkowych (RRI), parametr określany za pomocą ultrasonografii doplerowskiej, pozwala wykryć istotne hemodynamicznie zwężenia tętnic nerkowych. Chociaż wykazano, że niektóre czynniki ryzyka CAD, w tym nadciśnienie tętnicze i cukrzyca, są powiązane z RRI, bezpośrednia zależność między rozległością i złożonością CAD a wskaźnikiem RRI nie została dotychczas zbadana. Cel: Celem niniejszej pracy była ocena związku między wskaźnikami RRI i SYNTAX u pacjentów z ACS. Metody: Do tego przekrojowego badania włączono 235 chorych z rozpoznaniem ACS, u których wykonano koronarografię w ośrodku specjalistycznym autorów w okresie od lutego do sierpnia 2016 r. Na podstawie obrazu klinicznego można wyróżnić dwie grupy chorych: u 112 osób rozpoznano ACS bez uniesienia odcinka ST (NSTE-ACS), a u 123 osób — ACS z uniesieniem odcinka ST (STE-ACS). Odnotowano następujące informacje o uczestnikach: dane demograficzne, parametry kliniczne i laboratoryjne, wyniki badań echokardiograficznych, wskaźnik SYNTAX i parametry uzyskane w badaniu nerek metodą ultrasonografii doplerowskiej, w tym wskaźnik RRI, wskaźnik pulsacyjności (RPI) oraz czas akceleracji (AT). Wyniki: Spośród 235 uczestników badania u 112 (47,7%) rozpoznano NSTE-ACS, a u 123 (52,3%) — STE-ACS. Średnia wartości wskaźników SYNTAX i RRI u chorych z NSTE-ACS oraz STE-ACS wynosiły odpowiednio 15,4 i 0,69 oraz 21,1 i 0,67. Wskaźnik SYNTAX był związany z płcią, wzrostem, stężeniem kwasu moczowego w osoczu, wymiarem lewego przedsionka, wymiarami końcowoskurczowym i końcoworozkurczowym lewej komory, wskaźnikami RPI i RRI u pacjentów z NSTE-ACS, a także ze stężeniem cholesterolu całkowitego i frakcji LDL, frakcją wyrzutową oraz wymiarem późnoskurczowym lewej komory u chorych ze STE-ACS (p < 0,05 dla wszystkich zmiennych). Wskaźnik RRI wiązał się istotnie z wiekiem, stężeniem hemoglobiny, wymiarem lewego przedsionka, wartością wskaźnika SYNTAX, AT i wskaźnikiem RPI u chorych z NSTE-ACS oraz z masą ciała, wskaźnikiem masy ciała, grubością przegrody międzykomorowej w rozkurczu, grubością tylnej ściany lewej komory w rozkurczu, frakcją wyrzutową lewej komory i wskaźnikiem RRI u chorych ze STE-ACS. W wielozmianowej analizie regresji logistycznej wykazano, że wymiar późnoskurczowy lewej komory (β = 0,385; 95% CI 1,065–2,029; p = 0,019),wskaźnik RRI (β = 32,230; 95% CI 5343,15–2.E+24; p = 0,008) i wskaźnik RPI (β = –7,439; 95% CI 0,000–0,231; p = 0,015) były niezależnymi czynnikami predykcyjnymi średniej lub wysokiej wartości wskaźnika SYNTAX u pacjentów z NSTE-ACS. Wnioski: Wskaźnik RRI w badaniu nieinwazyjnym jest ściśle związany z rozległością i złożonością CAD u chorych z NSTE-ACS. Jednak potrzebne są randomizowane badania z grupą kontrolną obejmujące szerszą populację.

The Value of Fibrosis Index in Discrimination of Chronic Hepatitis and Cirrhosis

Aim: To evaluate the value of Doppler ultrasonography (US) and fibrosis index in differentiating between chronic hepatitis and cirrhosis. Methods: Sixty-seven non-cirrhotic viral hepatitis B and C patients and 28 cirrhotic patients were included in this study. All patients were examined by liver Doppler US. Quantitative Doppler parameters were obtained and fibrosis index was calculated. The results were evaluated statistically and a cut-off value for fibrosis index was obtained to differentiate between chronic hepatitis and cirrhosis groups. Results: The mean fibrosis index value in chronic hepatitis group and cirrhotic patients was 3.23±0.85 and 5.40±1.8, respectively. The difference between the two groups was statistically significant (p<0.05). Taking a cut-off value of 4.57 for fibrosis index, a sensitivity of 97% and a specificity of 71% were obtained. Conclusion: Fibrosis index may be valuable in monitoring of patients with chronic hepatitis and may be helpful in selecting patients who require biopsy