Relationship of vascular variations with liver remnant volume in living liver transplant donors

Background: In this study, we investigated the relationship between the portal vein and hepatic artery variations and the remaining liver volume in living donors in liver transplantation.Materials and methods: In the study, triphasic abdominal computed tomography images of 180 live liver donor candidates were analysed retrospectively. Portal veins were divided into four groups according to the Nakamura classification and seven groups according to the Michels classification. The relationship between vascular variations and remnant liver volume was compared statistically.Results: According to the Nakamura classification, there were 143 (79.4%) type A, 23 (12.7%) type B, 7 (3.9%) type C and 7 (3.9%) type D cases. Using the Michels classification, 129 (71%) type 1, 12 (6.7%) type 2, 24 (13%) type 3, 2 (2.2%) type 4, 10 (5.6%) type 5, 1 (0.6%) type 6, and 2 (1.1%) type 7 cases were detected. There was no significant difference in the percentage of the remaining volume of the left liver lobe between the groups (p = 0.055, p = 0.207, respectively).Conclusions: Variations in the hepatic artery and portal vein do not affect the remaining liver volume in liver transplantation donors

Performance of juvenile turbot (Scophthalmus maximus) fed varying dietary L-carnitine levels at different stocking densities

Commercial farming of turbot (Scophthalmus maximus) at high stocking densities may lead to growth depression and increasing production costs. Moreover, the high levels of accumulated waste in an intensive system may cause rapid deterioration of water quality, which may undermine the production. L-carnitine is known as a growth-enhancer which shows promise as mitigator of crowding effects. The effects of stocking densities (4, 8, 11 and 14 kg m²) on growth performance, feed utilization and body composition were evaluated during 75 days on turbot (75.6 ± 2.8 g) fed two dietary L-carnitine levels (40 or 240 mg kg¹). At the end of the feeding trial, total ammonia excretion (TAN) was measured postprandially for 24h. Specific growth rate and weight gain decreased with increasing stocking density. Fish held at 4 kg m² had higher final body weight (94-96 g) than fish held at higher densities (80-87 g). Protein efficiency ratio was higher in fish held at 4 kg m² (1.33-1.36), in comparison to fish stocked at 8 kg m² (0.98) or 14 kg m² (0.45). Voluntary feed intake decreased from 0.70 to 0.56% BW with increasing stocking density. Dietary L-carnitine supplementation did not affect growth performance and body composition, except for body L-carnitine content which increased from 75 to 128 mg kg¹ BW with supplementation. Fish fed 240 mg L-carnitine supplements had lower TAN that the ones fed 40 mg L-carnitine (p A aquicultura de pregado (Scophthalmus maximus) utilizando elevadas densidades pode reduzir o crescimento e aumentar os custos de produção. Elevados níveis de metabolitos gerados nestes sistemas intensivos provocam rápida deterioração da qualidade da água, podendo também comprometer a performance da produção. A L-carnitina atua como potenciadora do crescimento parecendo ser promissora por atenuar alguns desses efeitos. Os efeitos de densidades (4, 8, 11 e 14 kg m²) no desempenho do crescimento, composição corporal foram avaliados em pregados (75,6 ± 2,8 g) alimentados durante 75 dias a dois níveis dietéticos de L-carnitina (40 ou 240 mg kg¹). Após esse período, determinou-se a excreção de amônia pós-prandial durante 24 horas. Os peixes cultivados na menor densidade, 4 kg m², apresentaram melhores taxas de crescimento e ganho de peso (94-96 g) em comparação aos mantidos em altas densidades (80-87 g). A taxa de eficiência proteica foi mais elevada a 4 kg m² (1,33-1,36), do que a densidades de 8 kg m² (0,98) ou 14 kg m² (0,45). A ingestão voluntária de alimento decresceu de 0,70 para 0,56% do peso corporal com o incremento da densidade. A suplementação de carnitina não afetou o crescimento e a composição corporal, com exceção do conteúdo de carnitine da carcaça que passou de 75 a 128 mg kg¹. Peixes alimentados com suplementos de 240 mg L-carnitina apresentam excreção de amônia mais baixa comparativamente aos alimentados com 40 mg L-carnitina (p < 0,05)

Severe inflammatory and keloidal, allergic reaction due to para-phenylenediamine in temporary tattoos

PubMedID: 20228546Hair coloring with henna has been popular in Turkey for years. In recent years since the tattoos are applied by the street vendors in most of the beach places in Turkey, skin coloring with henna has also increased. Henna can be used alone or in combination with other coloring agents. Henna alone can be safe but due to additives such as para-phenylenediamine (PPD), p-toluenediamine and various essential oils, allergic contact reactions may occur. We report a 22-year-old man who developed severe inflammatory and keloidal, moderately bullous allergic reaction after henna paint-on tattoo. We did a patch test separately with these painting products (henna powder, PPD) and with the European standard series. PPD was strongly positive (+++) on day 2 and remained positive for following days. After treating with topical clobetasol-17 butyrate, resolution was obtained in two weeks. But some keloidal reaction remained

Granulomatous disorders

PubMedID: 24314377Almost all granulomatous skin disorders can cause red lesions on the face. Such disorders may include many bacterial, fungal, or parasitic infections, noninfectious inflammatory disorders, foreign body reactions, and even neoplasms. Clinically, they usually present with papules, plaques, nodules, and/or abscesses, which may ulcerate. It may be helpful in their differential diagnosis to define certain clinical patterns, such as multiple and discrete papules, necrotic or umbilicated papules or nodules, annular plaques, vegetative plaques or tumors, verrucous plaques or tumors, abscesses and/or sinuses, and lymphocutaneous pattern. Some disorders, such as sarcoidosis, can cause a wide variety of lesions. We accept that cutaneous leishmaniasis is also among such great imitators. © 2014 Elsevier Inc

Perfusion and diffusion magnetic resonance imaging in idiopathic intracranial hypertension

PubMedID: 16911348Objectives - Idiopathic intracranial hypertension (IIH) is characterized by abnormal elevation of intracranial pressure without any underlying etiologic factor. Papilledema is the major clinical finding whereas neuroradiological imaging findings are almost always normal. The aim of this preliminary study was to determine if diffusion and perfusion magnetic resonance imaging in patients with IIH might be beneficial in the management of the disease. Materials and methods - Prospectively, we evaluated standard magnetic resonance, magnetic resonance angiographies and venographies, diffusion and perfusion magnetic resonance findings of 16 patients with IIH and of 16 age-, sex-, and weight-matched normal individuals as a control group. Patients with IIH underwent a detailed neuroophthalmologic examination and lumbar puncture for evaluation of cerebrospinal fluid pressure. Magnetic resonance imaging was performed with 1.5 T equipment. Results - On physical examination, all patients had characteristic papilledema, varying degrees of headache, blurred vision and tinnitus. Cerebrospinal fluid pressure was higher than 250 mm H2O in all patients. A statistically significant decrease in cerebral blood flow in six patients, whereas insignificant increase in two were detected. Cerebral blood volume values were almost similar to normal control group's values. Significant mean transit time prolongation was found in six patients as well. Conclusions - Idiopathic intracranial hypertension is a clinical syndrome which requires prompt diagnosis and a thorough evaluation. Treatment is crucial for preventing visual loss and improving associated symptoms. It is also important to detect cerebral perfusion changes, as cerebrovascular complications may be associated. Although our patient group is small for statistical evaluation, it is a preliminary study using perfusion and diffusion magnetic resonance which may contribute to IIH management. © 2006 The Authors

The influence of training on the recognition of gross features of dermoscopy images

PubMedID: 20228541Background: In a dermoscopic examination, besides structural components, inexperienced clinicians should also be able to recognize the gross features of the images. Aim: The aim of this study is, whether or not an inexperienced clinician has problems in the recognition of gross features of the images on dermoscopic examination. Methods: Two dermatologists, of whom one was experienced in the field of dermoscopy and the other was not, examined 161 dermoscopic images of melanocytic lesions in the gross features of their borders. Inner and outer borders were defined for each lesion. Both dermatologists separately evaluated the borders of the lesions for irregularity, asymmetry, and wideness of fading. For subjective image analysis they scored each lesion by using the four-point ordinal scale. For computerized image analysis they manually marked borders with dots, by using a computer program. We used quadratic-weighted kappa for interobserver reliability assessments for subjective scores and intraclass correlation coefficients (ICC) for automatically calculated scores. Results: In a subjective evaluation the inexperienced observer used a higher score than the experienced observer and the kappa values were between 0.241 0.286. ICC for the automatically calculated scores were between 0.357 and 0.522. According to both the outer and the inner borders, the concordance between experienced and inexperienced observers was almost perfect in measurements of diameter, perimeter, and area (ICC scores were between 0.948 and 0.990). Conclusions: An inexperienced person, in comparison with an experienced person, sees lesions in the same sizes, but in different shapes on dermoscopy. Therefore, it is advisable that making learners familiar with the borders of lesions should be included in the training on dermoscopy

Evaluation of a guideline for etiological diagnosis of chronic urticaria [kronik ürtikerin etiyolojik tanisi i·çin geliştirilen rehberin degerlendirilmesi]

Background: Exhibiting potential causes of chronic urticaria in routine daily practice is a complex procedure. A guideline, developed by the researchers, investigating the etiology of chronic urticaria was evaluated in this study. In this guideline erythrocyte sedimentation rate, complete blood count, urine analysis and direct microscopic examination of stool for parasites were routine and other diagnostic procedures were requested according to clinical findings of potential causes. Objective: The purpose of the study was to determine the rate of implementation of the guideline considering a daily practice. Material and Methods: Following diagnosis of chronic urticaria, patients were interrogated with a standard questionnaire form, and were examined in order to determine the clinical findings of possible causes of the disease. The records of 903 patients in total were retrospectively evaluated. During the evaluation process, the necessary and unnecessary diagnostic procedures regarding the guideline were determined by using computerized algorithms. During evaluation some parameters such as age and gender of patients, duration and severity of the disease, and numbers and types of diagnostic procedures affecting the grade of the request and completion were also taken into account. Results: The total number of necessary procedures was 4070, less than one third of which were requested by the physicians. However, the patients completed more than three fourths of the requested procedures. Moreover, the physicians requested some unnecessary procedures in almost one third of the patients. Conclusion: According to clinical findings, lower threshold for necessity of investigation leads to more failure in implementation of a guideline. Guidelines developed for the etiological diagnosis of chronic urticaria should be evaluated retrospectively on data from daily practices to evaluate the utility of a guideline. © 2010 by Türkiye Klinikleri

Computer-Aided Diagnosis of Genodermatoses

PubMedID: 15160860Genodermatoses are not usually easily diagnosed by inexperienced physicians. We developed a computer program to aid their clinical diagnoses and compared its accuracy rate to those of five residents in dermatology. The database of the program contained the clinical findings of 100 genodermatoses. Findings related to the skin, its appendages, mucous membranes and physiognomy were recorded in detail; but the involvements of other organs, only as headings. Twenty test cases were prepared from previously published reports. Their clinical findings were evaluated both by the program and five residents, who were at the end of the third year of their training in dermatology. The program gave the correct diagnosis in all of the test cases, but the residents failed to do so in one to seven cases. The high accuracy rate of the program suggests that it can aid inexperienced physicians in their clinical diagnosis of genodermatoses