CLINICAL APPRAISAL AND RETINAL IMAGING IN POSTERIOR MICROPHTHALMOS

Purpose: To report a critical case series of five patients with posterior microphthalmos and the review of their clinical findings with the analyses of retinal imaging. Method: Case series. Complete ophthalmological examinations including optical coherence tomography (OCT) were evaluated. Results: All patients had decreased visual acuity with high hyperopic refraction. Dilated fundus examination demonstrated that elevated papillomacular retinal folds with anterior segment were unremarkable. Total axial lengths measurements showed reduced axial lengths and B-scan ultrasonography revealed sclerochoroidal thickening. Moreover, papillomacular folds were confirmed by OCT. Conclusion: Dilated fundus examination, fundus fluorescein angiography, orbital ultrasonography, and proper OCT evaluation will be helpful to reach a diagnosis.     

Incremental value of live/real time three‐dimensional transesophageal echocardiography over the two‐dimensional technique in the assessment of a tuberculoma involving the left atrium and appendage

Intracardiac tuberculomas are extremely rare, and cardiac involvement in tuberculosis accounts for only 0.5% of extrapulmonary tuberculosis. We report for the first time incremental value of live/real time three‐dimensional transesophageal echocardiography over two‐dimensional transesophageal echocardiography in the assessment of a tuberculoma involving the left atrium and left atrial appendage.     

Infection of Cranioplasty Seen Twenty Years Later

Cranioplasty is performed using autograft and allograft materials on patients to whom craniectomy was applied previously due to the facts that, this region is open to trauma and the scalp makes irritation and pressure onto the brain paranchyma causing brain atrophy and convulsions. Dramatical improvement of neurological deficits, control of convulsions and partial prevention of cerebral atrophy are achieved after these operations. One of the most important complications of cranioplasty is late infection. Here, we report a 43-year-old male patient admitted with the history of purulant discharge from the right temporal incission site for one year to whom cranioplasty had been performed with allograft material 20 days after craniectomy which had been performed in 1989. Allograft cranioplasty material was removed and cranioplasty was performed using new allograft material with the diagnosis of late cranioplasty infection.     

Comparison of subclinical left and right ventricular systolic dysfunction in non-dipper and dipper hypertensives: impact of isovolumic acceleration

Objectives: To evaluate subclinical left ventricular and right ventricular systolic impairment in dipper and non-dipper hypertensives by using isovolumic acceleration.

Methods: About 45 normotensive healthy volunteers (20 men, mean age 43?±?9 years), 45 dipper (27 men, mean age 45?±?9 years) and 45 non-dipper (25 men, 47?±?7 years) hypertensives were enrolled. Isovolumic acceleration was measured by dividing the peak myocardial isovolumic contraction velocity by isovolumic acceleration time.

Results: Non-dippers indicated lower left ventricular (2.2?±?0.4?m/s² versus 2.8?±?1.0?m/s², p?2 versus 3.5?±?1.0?m/s², p?=?0.012) compared with dippers. Left ventricular mass index (p?=?0.001), interventricular septal thickness (p?=?0.002) and myocardial performance index (p?p?=?0.002), mass index (p?=?0.001) and right ventricular myocardial performance index (p?Conclusion: The present study demonstrates that non-dipper hypertensives have increased left and right ventricular subclinical systolic dysfunction compared with dippers. Isovolumic acceleration is the only echocardiographic parameter in predicting this subtle impairment.     

Evaluation and Comparison of Charcot’s Triad and Tokyo Guidelines for the Diagnosis of Acute Cholangitis

Reliability of Charcot’s triad has long been questioned. Tokyo Guidelines committee published Tokyo Guidelines in 2007 and 2013. The aim of this study was to retrospectively examine the patients who had been treated with the diagnosis of acute cholangitis and evaluate 2007–2013 Tokyo criteria and Charcot’s triad. The files of the patients with acute cholangitis in a referral center were examined retrospectively. All patients were classified and evaluated according to 2007 and 2013 Tokyo criteria and Charcot’s triad; and results were compared. It was detected that 51.7 % of patients who did not meet Charcot’s triad were in definitive diagnosis group of both Tokyo criteria. Kappa value was calculated as 0.404 in the analysis of consistency between two Tokyo criteria. Two patients who had features sufficient to objectively make the diagnosis of acute cholangitis failed to meet the Tokyo criteria 2007 or 2013. Charcot’s triad is not sensitive and specific enough in the diagnosis of acute cholangitis. Revision of Tokyo 2007 criteria caused a change in the diagnostic status of 15 % of the patients. It is remarkable that kappa value can hardly be considered as a sign of moderate agreement between two Tokyo guidelines. Tokyo criteria should be supported and updated.