Morgagni hernia in a patient with Morquio syndrome

Summary Morgagni hernia is a type of congenital diaphragmatic hernia which constitutes 2–6% of congenital diaphragmatic hernia cases. Morquio syndrome, a type of lysosomal hydrolase deficiency, results in keratan sulphate accumulation and skeletal dystrophy. Other anomalies such as cardiac anomalies and trisomy 21 may accompany the Morquio syndrome; however Morgagni hernia has not been previously reported with this syndrome. A patient with Morquio syndrome that presented with bilateral Morgagni hernias is described. During surgery primary repair is preferred, however when there are large defects synthetic mesh grafts may also be used.     

Diagnostic performance of conventional diffusion weighted imaging and diffusion tensor imaging for the liver fibrosis and inflammation

Objective

To evaluate the diagnostic accuracy of liver apparent diffusion coefficient (ADC) measured with conventional diffusion-weighted imaging (CDI) and diffusion tensor imaging (DTI) for the diagnosis of liver fibrosis and inflammation.

Materials and methods

Thirty-seven patients with histologic diagnosis of chronic viral hepatitis and 34 healthy volunteers were included in this prospective study. All patients and healthy volunteers were examined by 3 T MRI. CDI and DTI were performed using a breath-hold single-shot echo-planar spin echo sequence with b factors of 0 and 1000 s/mm². ADCs were obtained with CDI and DTI. Histopathologically, fibrosis of the liver parenchyma was classified with the use of a 5-point scale (0–4) and inflammation was classified with use of a 4-point scale (0–3) in accordance with the METAVIR score. Quantitatively, signal intensity and the ADCs of the liver parenchyma were compared between patients stratified by fibrosis stage and inflammation grade.

Results

With a b factor of 1000 s/mm², the signal intensity of the cirrhotic livers was significantly higher than those of the normal volunteers. In addition, ADCs reconstructed from CDI and DTI of the patients were significantly lower than those of the normal volunteers. Liver ADC values inversely correlated with fibrosis and inflammation but there was only statistically significant for inflammatory grading. CDI performed better than DTI for the diagnosis of fibrosis and inflammation.

Conclusion

ADC values measured with CDI and DTI may help in the detection of liver fibrosis. They may also give contributory to the inflammatory grading, particularly in distinguishing high from low grade.     

Trace elements in nasal polyps

The aim of our study is to evaluate the status of selenium and zinc in nasal polyp tissues and to investigate the possible role of trace elements and antioxidants including superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in nasal polyps. In this study, the antioxidant enzyme and trace element levels measured in polyp tissues of 37 patients were compared with the levels measured in conchal mucosa of 27 control cases. The antioxidant enzyme and trace element levels in tissues were measured with graphite and flame spectrophotometry methods using Shimatsu UV.1601 spectrophotometer and Perkin Elmer atomic spectrometer. The mean tissue zinc and selenium levels were, respectively, 2.55 μg/g and 30.03 pg/g in patient group, 4.37 μg/g and 44.95 pg/g in control group. The mean tissue SOD and GSH-Px levels were, respectively, 4.27 and 0.69 U/mg protein in patient group, 7.09 and 0.77 U/mg protein in control group. When the measured levels in patients and control cases were compared, there were statistically significant differences between zinc, selenium, and SOD levels (P = 0.001). There was no significant difference between GSH-Px levels (P = 0.465). In conclusion, it has been revealed that the levels of zinc, selenium, and SOD in nasal polyps were significantly lower, and it may be concluded that this may have a role in the development of nasal polyps.     

Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery

BACKGROUND: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallbladder diseases. However, there still is a substantial proportion of patients in whom laparoscopic cholecystectomy cannot be successfully performed, and for whom conversion to open surgery is required. METHODS: In this study, 1,000 laparoscopic cholecystectomies performed at Ankara Numune Hospital, Fourth Department of Surgery, from March 1992 to July 1999 were prospectively analyzed. The patients studied included 804 women (80.4%) and 196 men (19.6%) with a mean age of 43.8 years (range, 30-80 years). From the data collected, only factors available to the surgeon preoperatively were considered for analysis. These factors included age, gender, history of acute cholecystitis, jaundice or pancreatitis, previous abdominal surgery, obesity and concomitant disease, white blood cell (WBC) count, preoperative liver function tests, ultrasound findings of the gallbladder, preoperative endoscopic retrograde cholangiopancreatography (ERCP), and suspicion of common bile duct stones. Also we analyzed the case numbers as a measure of institutional experience. RESULTS: Of the 1,000 patients in whom laparoscopic cholecystectomy was attempted, 48 (4.8%) required conversion to open surgery. The most common reason for conversion was inability to define anatomy in patients with inflamed contracted gallbladder (n = 34). Significantly independent predictive factors for conversion were male gender, previous abdominal surgery, acute cholecystitis, thickened gallbladder wall on preoperative ultrasonography, and suspicion of common bile duct stones. CONCLUSIONS: An appreciation for the aforementioned predictors of conversion will allow appropriate planning by the patient, the institution, and the surgeon.     

Factors affecting recurrence in tension-free hernioplasties

Summary We investigated the factors affecting recurrence rate in tension-free hernioplasties in the hope of obtaining better results. Tension-free hernioplasty is an easy procedure with very low reported recurrence rates of 0–1.7%. But the causes of failures in open mesh repairs have not been well estabushed. During this prospective study from January 1993 to December 1997 a total of 383 tension free hernioplasties were performed. The influence of some factors including age, sex, type of repaired hernia according to the Nyhus classification, simultaneous bilateral repair, previous hernia operation on the opposite side, chronic constipation, chronic obstructive lung disease, benign prostatic hypertrophy, smoking, previous appendectomy, early postoperative complications and surgical site infection on the recurrence rate were investigated using univariate and multivariate analyses. After a follow-up period of 16 to 62 months (mean 38.2 months) 5 out of 383 repairs failed with a recurrence rate of 1.3%. As a result of logistic regression analysis direct hernia, chronic constipation and surgical site infection were found to be independent risk factors for recurrence. The recurrence rates of tension-free hernioplasties can be reduced by the use of proper surgical techniques, early management of surgical site infection and treatment of chronic constipation.     

The involvement of distinct neural systems in patients with obsessive-compulsive disorder with autogenous and reactive obsessions

Besiroglu L, Sozen M, Ozbebit Ö, Avcu S, Selvi Y, Bora A, Atli A, Unal O, Bulut MD. The involvement of distinct neural systems in patients with obsessive–compulsive disorder (OCD) with autogenous and reactive obsessions. Objective: To investigate the regional metabolite abnormalities and changes after treatment in patients with OCD with autogenous and reactive obsessions. Method: We assessed right anterior cingulate cortex (ACC) and amygdala–hippocampal region (Am + Hpp) N‐acetyl‐aspartate (NAA), choline (Cho) and creatine (Cr) concentrations and NAA/Cr and Cho/Cr ratios using single‐voxel proton magnetic resonance spectroscopy in 15 patients with autogenous obsessions (OCD‐A), 15 patients with reactive obsessions (OCD‐R) and 15 healthy controls (HC). Measurements were repeated after 16 weeks of fluoxetine treatment. Results: Baseline ACC NAA/Cr ratios of both OCD groups were significantly lower than HC. OCD‐A group had significantly lower baseline NAA/Cr ratios in the Am + Hpp than other groups. These differences were more likely to be explained by higher Cr levels in ACC. We found no significant differences and changes for Cho levels and Cho/Cr ratios between groups and within groups. Significant increase in NAA/Cr ratios of OCD‐A group found in the Am + Hpp was more likely to be explained by increased NAA levels. No significant changes were found in ACC NAA/Cr ratios. Conclusion: While disturbed energy metabolism in ACC might reflect a common pathology in patients with OCD regardless of symptom dimension, alterations in mesiotemporal lobe are more likely for autogenous obsessions.     

Correction to: Nursing Students’ Experiences on Assessing the Sexuality of Patients: Mixed Method Study

Sexuality and Disability - The original version of the article was published with incorrect tables. The correct version of the tables is presented in this erratum.