Clinical improvement of a patient with severe Wilson's disease after a single session of therapeutic plasma exchange

Here, we report a case of a 17‐year old female with Wilson's disease presenting with progressive Coombs' negative hemolytic anemia and hepatic cirrhosis who was treated with one session of therapeutic plasma exchange (TPE) and clinically improved. In clinical situations where multiple sessions of TPE may not be possible, the use of a single session of TPE in conjunction with conventional therapy may be of benefit in preventing further clinical deterioration. J. Clin. Apheresis, 2009. © 2009 Wiley‐Liss, Inc.     

Spontaneous rupture of intrahepatic biliary ducts with biliary peritonitis.

Spontaneous rupture of intrahepatic biliary ducts is a rare cause of acute abdomen due to biliary peritonitis. We report a 92-year-old woman with 48-h history of upper abdominal pain, nausea and vomiting and peritoneal signs. CT scan showed free fluid in the abdomen and mild dilatation of the common bile duct. Exploratory laparotomy showed bile in the abdominal cavity with leak-age from a ruptured bile duct radicle in segment 3, as confirmed on intraoperative cholangiography. She underwent cholecystectomy, choledochotomy with removal of gallstones, repair of the perforation with primary suture and placement of a T-tube. She had an uneventful recovery.     

Neurovascularization of the anterior jaw bones revisited using high-resolution magnetic resonance imaging.

The anterior jaw bones are often considered relatively safe surgical sites. Nonetheless, the increasing rate of surgical interventions in that area, such as oral implant placement and bone grafting, has highlighted the potential risks and has raised the reported complications. A careful documentation of all anatomic variations in anterior jaw bone neurovascularization has thus become necessary. The present report attempts to revisit jaw bone neurovascularization, addressing typical anatomic appearances and variations. We summarize the results of various microanatomical studies carried out by high-resolution magnetic resonance imaging (HR-MRI) of the human anterior jaw bones. These studies reveal that edentulous and dentate anterior jaws present significant variation in the occurrence of the mandibular incisive canal and genial spinal foramina, as well as the maxillary nasopalatine canal. All of these canal structures contain a neurovascular bundle, whose diameter may be large enough to cause clinically significant trauma. A careful presurgical radiographic analysis of the anterior jaw bones is therefore advised.     

Unusual Kirschner wire migration as a late complication of Salter innominate osteotomy in developmental dislocation of the hip

Innominate osteotomy of Salter remains the most commonly used pelvic osteotomy for children in the age of 18 months to 6 years. Kirschner wire is inserted across the osteotomy site to fix the bone graft. We present an unusual case of migration of Kirschner wire through the abdominal region. Migration of pins to the femoral head is well-known complication. To our knowledge, this is the first case reporting migration of Kirschner wire through the abdominal region.     

Determination of the etiological organism during acute exacerbations of COPD and efficacy of azithromycin, ampicillin-sulbactam, ciprofloxacin and cefaclor. Turkish Thoracic Society COPD Working Group.

Acute exacerbations, most of which are due to lower respiratory tract infections, cause great morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD) and most of these are due to lower respiratory tract infections. The aim of this study was to determine the causative organism and the effects of azithromycin, ampicillin sulbactam (sultamicillin), ciprofloxacin and cefaclor monohydrate therapy in COPD. One hundred and six patients with COPD in acute exacerbation were randomized into four groups for empiric antibiotic treatment following lung function tests and sputum examination. The most common strains isolated from sputum were Haemophilus influenzae (30.8%), Streptoccocus pneumoniae (12%) and Moraxella catarrhalis (7.7%). Azithromycin, sultamicillin, ciprofloxacin and cefaclor monohydrate were found to be effective in treating COPD exacerbations.     

A study of variable origins of arteries in arm

A series of anomalous arterial supply of the arm and shoulder is presented. In these cases, the deep brachial artery arose from a common trunk with posterior circumflex humeral artery. In one case, the superior ulnar collateral artery and deep brachial artery originated from the posterior circumflex humeral artery. The common trunk or posterior circumflex humeral artery arose from the brachial artery at the level of the lower border of the teres major (at the origin of the brachial artery). A possible ontogenetic explanation is provided for this situation. Awareness of the variations of arteries of the arm or shoulder is important for angiographers and the surgeon who operates in this region. Preliminary part of this study was presented at the 1st Joint Meeting of EACA (European Association of Clinical Anatomy), AACA (American Association of Clinical Anatomists), Graz, Austria, 7–11 July, 2003.