Geographic Distribution of Multiple Arteries and Veins of 878 Kidney Donors From a Transplant Center in Turkey

AimThe diagnosis and management of multiple renal arteries and veins have gained importance with the increasing number of kidney transplantations and improved techniques in interventional radiology and vascular reconstructions. The aim of this study is to define and to detect the rate of multiple renal arteries and veins in our living kidney transplant donors coming from all parts of our country.MethodsAbdominal computed tomography angiogram findings of 878 kidney transplant donors were analyzed. The presence and the distribution of multiple renal arteries and veins in donors coming from 7 geographic regions in Turkey were noted.ResultsThe presence of multiple renal arteries was observed in 34% (48/141) of patients in the Marmara Region, 36.7% (79/215) of patients in the Black Sea Region, 37.2% (64/172) of patients in the Central Anatolia Region and 36.1% (30/83) of patients in the Southeastern Anatolia Region. The highest incidences of multiple renal arteries were observed in the Mediterranean and Aegean regions, affecting 40% (32/80) and 41.9% (26/62) of patients, respectively, while East Anatolia was found to have the lowest incidence, affecting 28% (35/125) of patients. The incidence of multiple renal veins also varied across regions. The highest incidence was observed in the Central Anatolia Region, where 23.3% (40/172) of patients were affected; the lowest was seen in the Aegean Region, where 11.3% (7/62) of patients were affected. In Turkey as a whole, 35.8% (314/878) of patients presented with multiple renal arteries, while the rate of multiple renal veins was found to be 19% (167/878) among our donors.ConclusionsAs 80% of the kidney transplantations performed in Turkey involve living donors, we think it will be useful to have knowledge of not only the presence of multiple renal arteries and veins, but also the distribution of this feature throughout the different regions of the country.     

Antenatally detected ureterocele: Associated anomalies and postnatal prognosis

ObjectiveWe purposed to review prenatal diagnoses of ureterocele, to determine the sonographic findings and additional abnormalities, and to illustrate the pregnancy outcomes of these patients.Material and methodsWe reviewed the records of 24 patients with the diagnosis of ureterocele in our referral center between January 2010–March 2017. Prenatal sonographic findings, antenatal course, and postnatal follow-up were obtained.ResultsThe mean gestational age at first US diagnosis was 24.5 ± 2.9 weeks. 13 (54.1%) of fetuses were female, and 11 (45.9%) were male. Ureterocele was associated with the duplex kidney in 17 (70.8%), MCDK in 5 (20.8%) and hydronephrosis with a single system in 1 (4.2%) and pelvic kidney in 1 (4.2%) fetuses. Postnatal follow-up was achieved in 22 of 24 (91.6%) cases, and mean follow-up interval was 56 ± 14.2. Months. The diagnosis of ureterocele was confirmed in 22 (91.6%) cases postnatally. 15 of 22 (68%) cases were classified as extravesical ureterocele, and 7 (32%) cases were intravesical ureterocele. Postnatal confirmation of duplex kidney achieved in 16 of 17 (94.1%) patients. 17 (77.2%) patients were required surgical intervention, and 5 (22.8%) cases were managed conservatively. 15 of 16 (93.7%) cases who were diagnosed duplex kidney underwent surgery however 2 of 5 (40%) cases which were confirmed MCDK required an operation. Cystoscopic ureterocele incision was the initial approach for the surgical management and performed all of the cases which required surgery. It was curative in 10 of 17 (58.8%) patients and 7 (41.2%) cases needed to further operations. Ureteroselectomy and common-sheath ureteroneocystostomy was performed in 5 (29.1%) cases and. 2 (%11.7%) cases underwent partial nephrectomy.ConclusionUreterocele can be accurately diagnosed by prenatal sonography, and it is a significant clue for the diagnosis of a duplex kidney. Postnatal prognosis depends on associated anomaly and presence of reflux and upper pole function.     

Clear cell odontogenic carcinoma of the maxilla

Clear cell odontogenic carcinoma (CCOC) is a rare odontogenic tumor associated with aggressive clinical behavior, metastasis and low survival. We report a case of CCOC affecting the maxilla of 62 year-old woman. It was first described as a clinicopathological entity in 1985 and to date only 67 cases were described in the English literature. We are understanding of the behavior of this carcinomas was depend on limited case reports. For these reason we found important to report this case of CCOC in the maxilla.     

Clinical correlates of worsening in obsessive-compulsive symptoms during pregnancy

This study examined clinical factors related to worsening of obsessive-compulsive disorder (OCD) in pregnant women. For comorbid diagnoses at the onset of pregnancy and frequency of several obsessive-compulsive symptoms, there was a significant difference between women whose OCD worsened during the pregnancy and those in whom the OCD did not worsen.     

Delirium Following Acute Myocardial Infarction: Incidence,Clinical Profiles,and Predictors

PURPOSE. To examine the incidence, clinical profile, and predictors of delirium following acute myocardial infarction (MI). DESIGN AND METHODS. The study sample included 212 consecutive patients with acute MI who were admitted to the coronary intensive care unit of a university hospital. FINDINGS. Delirium was found to occur in 5.7% of the patients. The predictors of delirium were advanced age, higher level of serum potassium at admission, and experience of cardiac arrest during MI. PRACTICE IMPLICATIONS. Delirium is reasonably prevalent in patients with acute MI. We propose that patients with the risk factors that have been delineated in this study should be evaluated carefully.     

Annular Plaques on the Tongue: What Is Your Diagnosis?

Geographic tongue is an inflammatory disorder of the tongue characterized by asymptomatic erythematous patches with serpiginous borders. Candidiasis of the tongue may be confused with geographic tongue. A 63-year-old male patient with painful white annular lesions localized to the left side of his tongue is presented. He applied topical corticosteroid and antiinflammatory agents, but his lesions did not respond to those therapies. Using direct mycologic examination and culture, the patient was diagnosed with candidiasis. After systemic and topical antifungal therapy, clinical improvement was observed. With this case, the clinical forms of oral candidiasis were discussed, and it was suggested that the clinical presentation of mucosal candidiasis may vary according to the stage of infection and individual immunity.     

MR motility imaging in Crohn’s disease improves lesion detection compared with standard MR imaging

Objective

To evaluate retrospectively in patients with Crohn’s disease (CD) if magnetic resonance (MR) motility alterations correlate with CD typical lesions leading to an increased detection rate.

Methods

Forty patients with histologically proven CD underwent MR enterography (MRE), including coronal cine sequences (cine MRE), in addition to the standard CD MR protocol. Two blinded readings were performed with and without cine MRE. Locations presenting motility alterations on the cine sequences were analysed on standard MRE for CD-related lesions. This was compared with a second reading using the standard clinical MRE protocol alone.

Results

The number of lesions localised by cine MRE and identified on standard MRE compared with standard MRE alone were 35/24 for wall thickening (p?=?0.002), 24/20 for stenoses (p?=?0.05), 17/11 for wall layering (p?=?0.02), 5/3 for mucosal ulcers (p?=?0.02) and 21/17 for the comb sign (p?=?0.05). Overall, cine MRE detected 35 more CD-specific findings than standard MRE alone (124/89; p?=?0.007) and significantly more patients with CD-relevant MR findings (34/28; p?=?0.03).

Conclusion

CD lesions seem to be associated with motility changes and this leads to an increased lesion detection rate compared with standard-MRE imaging alone.