Saccular distal aorta aneurysm accompanying aortic coarctation

Aortun konjenital darlıgı olan aort koarktasyonu, sıklıkla inen aortun proksimal kesimini tutar. Aort koarktasyonuna eslik eden serebral anevrizmalar ve koarkte segmentin proksimalindeki aort anevrizmaları, göreceli sık rastlanan komplikasyonlar arasında yer alırlar ve aortik rüptür ve anerizma rüptürü gibi ölümcül sonuçlara neden olabilirler. Cerrahi tedavi uygulanan olgularda görülen psödoanevrizmalar da koarktasyon ile iliskili ve sık görülen komplikasyonlar arasında sayılabilir. Bununla birlikte, koarkte segmentin distalinde sakküler ya da fuziform yapıda aort anevrizması görülmesi nadir bir durumdur. Bu yazıda; gögüs agrısı ve solunum güçlügü nedeniyle arastırılırken aort koarktasyonu ve distal ucunda sakküler aort anevrizması saptanan 75 yasındaki erkek hasta, bilgisayarlı tomografi bulguları ile sunulmaktadır.Aortic coarctation is the congenital narrowing of aorta and is usually located at the level of proximal descending aorta. Aortic aneurysms proximal to the coarcted segment and cerebral aneurysms are frequently associated with coarctation of aorta and rupture of these lesions lead to fatal consequences. Another complication accompanying coarctation is the pseudo-aneurysm seen in surgically corrected coarctation. However, saccular or fusiform aortic aneurysm distal to the coarcted segment is a very rare condition. In this paper; computed tomography findings were presented in a 75-year-old man with saccular aneursm of the descending aorta associated with aortic coarctation

Review of transrectal ultrasonography findings in the diagnosis of prostate cancer: radiopathological correlation

Amaç: Transrektal ultrasonografi (TRUS) esliginde prostat biyopsisi yapılan hastaları gözden geçirmek ve prostat kanseri tanısında yardımcı olabilecek ultrasonografik kriterleri degerlendirmek. Yöntem: Ocak 2003-Temmuz 2005 tarihleri arasında TRUS esliginde prostat biyopsisi alınan ve PSA degerleri gri zonda yer alan (410 ng/dl; ortalama PSA: 6.9 ± 2.7 ng/dl) 129 hasta retrospektif olarak degerlendirildi. TRUS\ud bulguları patoloji sonuçlarıyla karsılastırıldı. Periferik zon ekoyapısı (homojen ya da heterojen) ve prostat bezi konturları (düzgün ya da düzensiz) subjektif olarak sınıflandı. Bulgular: 44 hasta (% 34) prostat kanseri tanısı aldı. Incelenen kriterlerden periferik zon ekoyapısı ile periferik zonda hipoekoik nodül varlıgının patoloji sonuçlarıyla istatistiksel olarak anlamlı biçimde iliskili oldugu saptandı (p=0.000 ve p=0.007). Prostat kanseri yakalama olasılıgının, periferik zonun heterojen oldugu durumda 7 kat [Odds Oranı (OO): 7.06 (2.98-16.70) % 95 Güven Aralıgı (GA)], periferik zonda hipoekoik nodül varlıgında ise 3 kat [OO: 2.73 (1.18-6.28)%95 GA] arttıgı görüldü. Sonuç: Prostat kanseri tanısında TRUS'nin yeri sınırlıdır ve daha çok biyopsi kılavuzu olarak kullanılır. Bununla birlikte, bu çalısmanın sonuçları bahsedilen TRUS bulgularının varlıgında kanser yakalama olasılıgının anlamlı biçimde arttıgını ortaya koymaktadır. Nodüle yönelik biyopsi protokollerine benzer sekilde heterojen periferik zon varlıgında alınan biyopsi örneklerinin sayısının artırılmasına dayanan bir çalısma planı ile sunulan çalısmanın geçerliligi degerlendirilebilir.Purpose: To overview transrectal ultrasonography (TRUS) guided prostate biopsy cases and to evaluate the potentially useful sonographic criteria for the diagnosis of prostate cancer. Methods:Between January 2003 and June 2005, TRUS guided prostate biopsy specimens were obtained from 129 patients with a gray zone PSA level (4 - 10 ng/dl; average PSA: 6.9 ± 2.7 ng/dl). TRUS findings were compared with pathology results. Peripheral zone echostructure (homogenous or heterogeneous) and prostate contours (smooth or irregular) were classified subjectively. Presence of a hypoechoic nodule in the peripheral zone was noted, additional samples were obtained from the nodules. Results: 44 patients (34%) were found to have prostate adenocarcinoma. A statistically significant relationship was found between the peripheral zone echostructure - presence of hypoechoic nodule in the peripheral zone and pathological results (p=0.000 and 0.007, respectively). Prostate cancer detection rate increased 7 folds [Odds Ratio (OR): 7.06 (2.98-16.70) 95% Confidence Interval (CI)] when the peripheral zone was heterogeneous and 3 folds [OR: 2.73 (1.18-6.28) 95% CI] when there was a hypoechoic nodule in the peripheral zone. Conclusion:TRUS has a limited role in the diagnosis of prostate cancer and is especially used for biopsy guidance. On the other hand, the results of this study reveal a significant increase in cancer detection rate when the mentioned TRUS findings are present. Similar to the nodule targeted biopsies; the accuracy of the presented study can be evaluated with a prospective study including a larger number of biopsy specimens in case of peripheral zone heterogenity

The rare cause of respiratory distress in newborn: congenital cystic adenomatoid malformation of lungs

Yenidogan döneminde solunum sıkıntısı ile karsılasıldıgında, nadir olarak rastlansa da, akcigerlerin konjenital anomalilerinin hatırlanması amacıyla bu olgu sunulmustur. Konjenital kistik adenomatoid malformasyon nadir rastlanan ancak hayatı tehdit eden bir akciger anomalisidir. Yaklasık 25000 dogumda bir görülür. Dogumun ilk saatlerinde baslayan solunum sıkıntısı nedeni ile yenidogan yogun bakım ünitesine sevk edilen olgunun fizik muayenesinde solunum sıkıntısı bulguları ve pektus ekskavatus deformitesi mevcuttu. Akciger grafisinde, sol akcigerde kaba retikülogranüler görünümü, toraks bilgisayarlı tomografisinde (BT) sol akcigerde parankim içerisinde çok sayıda, yaygın, degisik boyutta hava kisti saptandı. BT ve akciger grafi bulguları ile konjenital kistik adenomatoid malformasyon Tip III ile uyumlu olarak degerlendirildi. Olgu yasamının onuncu gününde mekanik ventilatörde izlenmekte iken kaybedildi.The aim of presenting this case is that; the congenital lung abnormalities are rare, but important of differential diagnosis in newborn respiratory distress.The congenital cystic adenomatoid malformation is a rare but potentially life-threatening pulmonary anomaly. It is reported 1 in 25000 pregnancies. Respiratory distress, pectus excavatus deformity were detected in the physical examination of the infant who was accepted to our newborn intensive care unit in the first hours of his life. In the chest X-ray there was reticulogranular appearance in left lung and there was multiple, diffuse cysts which were in different size in lung parenchyma in the computerize tomography (CT) examination. The signs on the CT and X-ray were accepted as a congenital cystic adenomatoid malformation type III. The case died at his tenth day of the life during assisted mechanical ventilation

Ultrasonographic evaluation of gall bladder function ın patients with the ırritable bowel syndrome

ırritabıl barsak sendomu, sadece kalın barsağı ilgilendiren motilite bozukluğu olmayıp; özofagus, ince barsak ve hatta mesane de etkilenebilir. Değişen motilitenin nedeni belirgin olmamakla birlikte; son zamanlarda ıBS'de otonom sinir sistemi bozukluklarının ve anormal kolesistokinin salınımının etken olabileceği bildirilmektedir. şubat- Haziran 1999 ayları arasında prospektif olarak yapılan bu çalışma, irritabıl barsak sendromlu 28 hasta (5 erkek, 23 kadın; yaş ortalamaları 4311,8), 20 sağlıklı birey (13 erkek, 7 kadın; yaş ortalamaları 29,8 10,5), toplam 48 kişi ile gerçekleştirildi. Hastalar Manning'e göre irritabıl barsak sendromu kriterlerine uyan kişilerden seçildi. Safra koliği, sarılık ve gastrointestinal sistem cerrahisi geçirmiş bireyler çalışma grubuna alınmadı. Hastalar, klinik değerlendirme sonrası ultrasonografik olarak incelendi. Uzun süreli açlığı takiben yapılan ultrasonografide; safra kesesinin hacmi, duvar kalınlığı ve koledok çapı ölçüldü. Aynı ölçümler safra kesesi kontraksiyonunun sağlandığı kırkbeşinci dakika tokluk zamanında tekrarlandı. Açlık ve tokluk hacimlerinden safra kesesinin ejeksiyon fraksiyonu hesaplandı. Duvar kalınlığı, koledok çapı, ejeksiyon fraksiyonu arasında iki grup arasında anlamlı farklılık bulunmadı (p>0,05).Yalnızca postprandial volüm ölçümlerinde iki grup arasında istatistiksel olarak anlamlı fark mevcuttu (p<0,05). Çalışmamızda safra kesesinin ejeksiyon fraksiyonunda anlamlı fark saptanmamıştır. Ancak postprandial hacimlerdeki farkın anlamlı oluşu, irritabıl barsak sendromunda safra kesesinin de etkilenebileceği görüşünü destekleyebilir.Colon is not the only organ affected by the irritable bowel syndrome. Oesophagus, stomach and even urinary bladder may also be involved. The cause of the alteration of motility is not apperent, but nowadays, autonomic nervous system disorders and abnormal release of the cholecystokinin are blamed for this disorder. This prospective study was conducted between February and June 1999. The study population was composed of 28 irritable bowel syndrome patients ( 5 men, 23 women; average age 43 ± 11,8 years) and 20 healthy subjects ( 13 men, 7 women; average age 29,8 ± 10,5 years). The patient group was selected according to Manning's criteria for irritable bowel syndrome. Patients who described jaundice, biliary colic or gastrointestinal surgery were excluded. After clinical examination, patients were evaluated with ultrasonography following a 10 hour fasting period. Gall bladder volume, thickness of the wall and the diameter of the bile duct were measured. Same measurements were repeated 45 minutes after a fatty meal. Ejection fraction of the gall bladder was calculated from the fasting and postprandial volumes. There was no statistically significant difference between the two groups in terms of wall thickness, bile duct diameter and ejection fraction. A statistically significant difference was found between the postprandial volumes of the patient and control groups. In this study, no statistically significant difference was observed for ejection fraction. However, a significant difference between postprandial volumes of patients versus controls may support the hypothesis that gall bladder function can be affected in irritable bowel syndrome

Outcome of Very Low and Low Birth Weight Infants with Esophageal Atresia: Results of the Turkish Esophageal Atresia Registry

Introduction The data of the Turkish Esophageal Atresia Registry (TEAR) was evaluated to define the outcome of very low birth weight (VLBW) and low BW (LWB) infants with esophageal atresia (EA)

The effect of azygos vein preservation on postoperative complications after esophageal atresia repair: Results from the Turkish Esophageal Atresia Registry

Aim: Preservation of the azygos vein (AV) maintains normal venous drainage of the mediastinum and decreases postoperative congestion. The modification of esophageal atresia (EA) repair by preserving AV may prevent postoperative complications and may lead to better outcomes. The data from the Turkish Esophageal Atresia Registry (TEAR) were evaluated to define the effect of AV preservation on postoperative complications of patients with EA. Methods: Data from TEAR for a period of five years were evaluated. Patients were enrolled into two groups according to the preservation of AV. Patients with divided (DAV) and preserved AV (PAV) were evaluated for demographic and operative features and postoperative complications for the first year of life. The DAV and PAV groups were compared according to the postoperative complications, such as fis-tula recanalization, symptomatic strictures, anastomotic leaks, total number of esophageal dilatations, and anti-reflux surgery. In addition, respiratory problems, which required treatment, were compared between groups. Results: Among 502 registered patients; the data from 315 patients with the information of AV ligation were included. The male female ratio of DAV (n = 271) and PAV (n = 44) groups were 150:121 and 21:23, respectively (p > 0.05). The mean body weight, height, gestational age, and associated anomalies were similar in both groups (p > 0.05). The esophageal repair with thoracotomy was significantly higher in DAV group, when compared to the PAV group (p 0.05). There was no difference between DAV and PAV groups for anastomotic leaks, symptomatic anastomotic strictures, fistula recanalization, and the re-quirement for anti-reflux surgery (p > 0.05). The rate of respiratory problems, which required treatment, was significantly higher in the DAV group (p < 0.05) Conclusion: The data in the TEAR demonstrated that preserving the AV during EA repair led to no sig-nificant advantage on postoperative complications, with exception of respiratory problems. AV should be preserved as much as possible to maintain a normal mediastinal anatomy and to avoid respiratory com-plications. (c) 2020 Elsevier Inc. All rights reserved