Contrast-enhanced MRI of the small bowel in Crohn��s disease

Recently, magnetic resonance imaging has emerged as a valuable tool in evaluation of small bowel Crohn’s disease. MRI provides several advantages to other imaging modalities, including the lack of ionizing radiation, multiplanar capability, and functional information. Intravenous contrast administration is a routine portion of MR enterography protocol, and aids in detection of disease extent, extramural complications such as fistula and abscess, and assessment of activity. Additionally, promising techniques such as dynamic contrast-enhanced MRI may provide quantitative measures to assess bowel perfusion, which may enhance evaluation of disease activity. This article will provide an overview of the technical aspects of contrast-enhanced MR enterography, describe common pathologic findings involving the small bowel in Crohn’s disease, summarize its role in determination of activity with an emphasis on endoscopic and histologic correlation, and compare its efficacy with other imaging modalities.     

Cementless total hip arthroplasty for the management of tuberculosis coxitis

Introduction  

Tuberculosis arthritis of the hip is a crippling disease and there is need for an effective and acceptable treatment for the hips with bone destruction. The aim of this report was to evaluate the efficacy of the diagnostic method for hip tuberculosis and clinical results of the patients to clarify the question of whether a total hip arthroplasty (THA) should be attempted on a patient with a current or previous infection.     

Giant pilomatrixoma

. Pilomatrixoma is most commonly seen in the head and neck region, occurring in the first two decades of life. It varies from 0.5 cm to 3 cm in diameter. Pilomatrixoma differentiates toward hair cells. Treatment of choice is excision. A 42-year-old woman presented with a giant painful pilomatrixoma, 5 cm in diameter, in the forearm. It had gradually grown larger over a period of years. Physical examination revealed a painful, red-brown colored, ulcerative, mobile mass, 50 mm in diameter, with surrounding hyperemia. Histopathological examination of the specimen provided the diagnosis of "pilomatrixoma". The mass was totally excised, and the resultant tissue defect was repaired with a full-thickness skin graft from the inguinal area. Two years later, there was no recurrence and the postoperative scar was cosmetically acceptable. Generally, there is no recurrence if the pilomatrixoma is totally resected. The case presented in this paper is of interest because the lesion had a large diameter, appeared in the fourth decade, and had a "faceted stone" appearance with perforation of the overlying skin. It is important to differentiate this lesion from a pilomatrix carcinoma.     

Psoas abscess as a complication of pyogenic sacroiliitis: report of a case

A psoas abscess is, either primary or secondary, a rare entity for a general surgeon. Images by ultrasonography and computed tomography (CT) can help a general surgeon to make an accurate diagnosis when encountering the patient complaining of unilateral lower abdominal deep pain with fever. A case of pyogenic abscess of the psoas muscle as a result of sacroiliitis in a 22-year-old man is reported herein. The abdominal CT and magnetic resonance imaging scans demonstrated a large multilocular abscess extending along the iliopsoas muscle, and erosion and a widening of the left sacroiliac joint. The abscess was drained with an open surgical approach and the patient responded well to antibiotic therapy. Aggressive surgical and medical treatment is necessary in patients with psoas abscess to prevent complications. Received: March 5, 2001 / Accepted: November 20, 2001     

In vitro effects of dantrolene sodium and verapamil on noradrenaline-induced contractions of rabbit aorta and their interactions

The effects of dantrolene sodium (0.1 to 10 microM) and verapamil (0.01 to 1 microM) administered alone or together (1 microM verapamil, 0.1 to 10 microM dantrolene sodium) were investigated in isolated rabbit thoracic aorta precontracted with 0.1 microM noradrenaline (NA). Verapamil plus dantrolene sodium produced a dose-dependent inhibition of aortic strips contractions evoked by NA, and all concentrations of dantrolene sodium significantly decreased the inhibitory effect of 1 microM verapamil (p < 0.001, ANOVA). In conclusion, dantrolene sodium and verapamil inhibited 0.1 microM noradrenaline-evoked aorta contractions, and all doses of dantrolene sodium decreased the inhibitory effect of 1 microM verapamil in a dose-dependent manner.     

Distribution of blood pressures in Gemlik District,north-west Turkey

The objectives of the present study were to evaluate the prevalence, awareness and control of hypertension among individuals over 30 years of age and to plan a follow-up programme for the same age group. A community-based sample of 1992 individuals (952 men and 1,040 women) was selected randomly. Out of the total study population, 1,388 (69.7%) individuals had normal blood pressure according to World Health Organisation criteria (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg), and the rest (n = 604, 30.3%) had hypertension to varying degrees. Since 61 individuals with normal blood pressure were using antihypertensive medication, the overall hypertension prevalence was 33.4%. Among the study subjects with hypertension, 44.4% were aware of their condition, 37.7% were using medication and 9.2% had controlled hypertension. One out of five individuals (n = 399, 20.0%) had never had their blood pressure measured before. Females had a higher hypertension prevalence than males (36.7% and 29.7%, respectively). Hypertension prevalence increased with age and individuals with a body mass index > 25 were at greater risk. The present findings suggest that there is a need to implement an effective, community-based and low-cost management programme.     

Effects of the electromagnetic field of mobile telephones on hearing

The widespread use of mobile telephones has given rise to concern about the potential influences of electromagnetic fields (EMFs) on human health. Anatomically, the ear is in close proximity to the mobile telephone during use. Hearing loss due to mobile telephone use has not been described in the medical literature; however, if there is a subtle cochlear involvement, it might be detected by means of changes in evoked otoacoustic emissions (OAEs). Thirty volunteers with normal hearing were exposed to mobile telephone EMFs for 10 min and evoked OAEs were measured before and after exposure. No measurable change in evoked OAEs was detected and none of the subjects reported a deterioration in hearing level. To the best of our knowledge, this is the first study on the effects of EMFs emitted by mobile telephones on hearing. It was concluded that a 10-min exposure to the EMF emitted from a mobile telephone had no effect on hearing, at least at outer ear, middle ear and cochlear levels.     

Brucellosis: a retrospective evaluation

One hundred and sixty-six presumed brucellosis patients were included in the study. These patients were classified as primary (91), relapse (18) and suspected (57) cases according to their clinical presentations, and serologic and microbiologic test results. Primary and relapse cases were evaluated retrospectively according to age, sex, residence, routes of transmission, clinical and laboratory findings, treatment regimens, duration of treatment, and relapse rates. Of the 109 primary and relapse patients, 57 were male and 52 female. The ages of the patients ranged between 16-75 (mean age 40.2). The percentages of the urban and rural residence of the patients were 41.3% and 58.7%, respectively. The most common mode of transmission was consumption of unpasteurized milk and milk products (67.9%). Malaise, fever and sweating were the most frequently observed symptoms (96.3%, 95.4%, 91.7%, respectively). The most common signs were fever (97.2%), splenomegaly (59.6%), and hepatomegaly (37.6%). The liver was the most frequently involved organ (21.1%). Almost all (99.1%) patients were serologically positive. However, the positivity rate of culture was low (15.6%). The most frequently preferred antimicrobial regimen was rifampin and doxycycline combination. The relapse rate was 8.3%. Brucellosis is still prevalent in Turkey as in many other countries in the Mediterranean basin. The clinical presentation of the disease may show regional variations. Patients with a history of occupational or nutritional contact with the bacterium and with a compatible clinical picture should be examined using appropriate diagnostic techniques before any attempt to prescribe an antimicrobial.     

Treatment modalities and outcome of the renal victims of the Marmara earthquake

BACKGROUND/AIMS: Circulating CD14+CD16+ monocytes, a potent phagocytosing and antigen-presenting monocyte population, have been reported to be expanded in patients on hemodialysis (HD). In this study, changes in the population of CD14+CD16+ monocytes were analyzed during a single session of HD therapy, and the influence of dialyzer membrane materials on these monocytes was investigated. METHODS: Nine patients were hemodialyzed using regenerated cellulose (RC) membranes and thereafter polysulfone (PS) membranes. Peripheral blood cells were taken from these subjects, and these cells were stained with anti-CD14 and anti-CD16 antibodies. The percentages of CD14- and CD16-expressing monocytes were analyzed by two-color flow cytometric analysis. Moreover, the serum soluble CD14 (sCD14) levels were measured with an ELISA kit. RESULTS: It was found that CD14+CD16+ monocytes before HD were significantly increased in patients on HD as compared to healthy controls. In the RC group, CD14+CD16+ monocytes were decreased at both 30 and 240 min after the initiation of HD. The reduction rate of CD14+CD16+ monocytes in the RC group was higher than that in the PS group. There was no significant difference in sCD14 levels between the two groups. CONCLUSION: Monocytes are activated in patients on HD. Furthermore, the population of CD14+CD16+ monocytes was stimulated to a greater extent during HD in the RC group than in the PS group. The significant reduction in CD14+CD16+ monocytes by RC membranes indicated that the level of CD14+CD16+ monocytes is a sensitive marker for the biocompatibility of HD membranes.     

Renal replacement therapies in the aftermath of the catastrophic Marmara earthquake

BACKGROUND: Renal replacement therapy is of vital importance in the treatment of crush syndrome victims, who are frequently encountered after catastrophic earthquakes. The Marmara earthquake, which struck Northwestern Turkey in August 1999, was characterized by 477 victims who needed dialysis. METHOD: Within the first week of the disaster, questionnaires containing 63 clinical and laboratory variables were sent to 35 reference hospitals that treated the victims. Information considering the features of dialyses obtained through these questionnaires was submitted to analysis. RESULTS: Overall, 639 casualties with renal complications were registered, 477 of whom (mean age 32.3 +/- 13.7 years, 269 male) needed dialysis. Among these, 452 were treated by a single dialysis modality (437 intermittent hemodialysis, 11 continuous renal replacement therapy and 4 peritoneal dialysis), while 25 victims needed more than one type of dialysis. In total, 5137 hemodialysis sessions were performed (mean 11.1 +/- 8.0 sessions per patient) and mean duration of hemodialysis support was 13.4 +/- 9.0 days; this duration was shorter in the non-survivors (7.0 +/- 8.7 vs. 10.0 +/- 9.8 days, P = 0.005). Thirty-four victims who underwent continuous renal replacement therapy had higher mortality rates (41.2 vs. 13.7%, P < 0.0001). Only eight victims were treated by peritoneal dialysis, four of whom also required hemodialysis or continuous renal replacement therapy. The mortality rate in the dialyzed victims was 17.2%, a significantly higher figure compared to the mortality rate of the non-dialyzed patients with renal problems (9.3%; P = 0.015). CONCLUSION: Substantial amounts of dialysis support may be necessary for treating the victims of mass disasters complicated with crush syndrome. Dialyzed patients are characterized by higher rates of morbidity and mortality.