Evaluation of hepatic functions and biliary dynamics in patients with liver cirrhosis by quantitative scintigraphy

BACKGROUND/AIMS: Aim of the study is to determine the changes in hepatocyte and gallbladder motor functions, and biliary dynamics in patients with liver cirrhosis. METHODOLOGY: The study group consisted of 17 patients with liver cirrhosis (12 males, 5 females) who were diagnosed by clinical, laboratory and histopathologic findings. Control group consisted of 20 healthy persons (14 males, 6 females). Quantitative hepatobiliary scintigraphy was performed by using Tc99m-Mebrofenin i.v. and dynamic images were obtained and evaluated quantitatively by computer. Maximum excretion time of radiodiagnostic agent by liver (Tmax) and half excretion time of radio-diagnostic agent from liver (T 1/2), gallbladder filling time, gallbladder ejection fraction and the transit time of bile to duodenum were determined. RESULTS: Mean values of Tmax was 25.76 vs. 12.40 min, T 1/2 was 37.55 vs. 23.15 min, gallbladder filling time was 53.35 vs. 30.57 min, and transit time of bile to duodenum was 39.88 vs. 25.00 min in the patients and control group, respectively. These values increased significantly in the patient group (p < 0.05) compared to controls. Mean gallbladder ejection fraction was 37.55% in the patient group and 41.84% in the control group without any statistical significance (p > 0.05). The incidence of gallbladder stone was 29.41% in the cirrhosis group and 5% in the control group (p < 0.05). CONCLUSIONS: The quantitative hepatobiliary scintigraphy is a simple and reliable method in evaluation of hepatic functions and biliary dynamics in cirrhotic patients. Although the incidence of gallbladder stone is significantly increased in cirrhotic patients, it seems that a stone in the gallbladder does not affect the gallbladder motor functions.     

Evaluation of oral isotretinoin effects on hearing system in patients with acne vulgaris: Reversible or not?

Systemic isotretinoin is commonly used for severe acne treatment. It has many side effects, one of these is about hearing system, which has rarely been reported, also previous studies reported contradictory results about systemic isotretinoin and its association with hearing system. In this study, we aimed to investigate whether systemic isotretinoin affected on the hearing system or not. The study included 32 acne vulgaris patients (64 ears) who treated with oral isotretinoin 0.5 mg/kg body weight for at least 4 months and audiometric tests including pure‐tone, speech, bilateral acoustic reflexes, and tympanometric measurements were performed at baseline, in the first week, in the first month, and third month of treatment, and sixth month after treatment. Audiometric tests were performed for right and left ears separately. A significant difference was found in the pure‐tone thresholds (before treatment, first week, first month, third month of treatment, and sixth month after treatment) for the both ears at 8000 Hz (P < .001) and a significant decrease in the sixth month post‐treatment pure‐tone thresholds compared to pre‐treatment thresholds at 8000 Hz. Additionally, a statistically significant increase was observed in serum LDL and triglyceride levels in the third month of treatment and a significant decrease at the sixth month after treatment (P < .001). Systemic isotretinoin caused bilateral hearing threshold changes in acne patients during the therapy but the changes improved after discontinuation. Therefore, our findings may provide safety using for dermatologists about hearing effects of isotretinoin, which is quite effective on severe acne.     

Pseudoaneurysm of the genicular artery after wound closure using a skin stapler in a child

A 9‐year‐old child with a left humerus fracture also had minor skin cuts on the right knee, which were closed with a skin stapler. After 1 week, a medial superior genicular artery pseudoaneurysm developed, which was treated by ultrasound‐guided compression. This case illustrates a unique complication of the use of a skin stapler device.© 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 41:316–318, 2013     

No Strong Association Between HER-2/neu Protein Overexpression and Gene Amplification in High-grade Invasive Urothelial Carcinomas

The generation of urothelial carcinoma is caused by the accumulation of various molecular changes, as in most malignancies. There are conflicting data about the status of HER-2/neu oncogene in urothelial carcinomas. The aim of this study was to determine the status of HER-2/neu oncogene in high-grade invasive urothelial carcinoma of urinary bladder both in protein and DNA level. We evaluated HER-2/neu protein overexpression by immunohistochemistry (IHC) and gene amplification by fluorescent in situ hybridization (FISH) and real-time quantitative PCR in paraffin-embedded samples of high-grade invasive urothelial carcinoma obtained from 36 patients. Polysomy 17 was also assessed by FISH. Immunohistochemically, HER-2/neu protein overexpression was observed in 22 (61.1%) tumors (ten tumors with score 3+ and 12 with score 2+). Fourteen of 36 tumors (38.9%) were evaluated as negative (score 0 or 1+). Complete concordance between FISH and the PCR was seen in all of the samples scored as 0 and 1+ by IHC. HER-2/neu gene amplification was observed in three of 27 (11.1%) tumors by FISH (nine samples were non-informative) and in eight of 36 (22.2%) tumors by the PCR. The complete concordance between HER2-2/neu protein overexpression and gene amplification was seen only in three of 27 tumors. Polysomy 17 was seen in nine tumors (33.3%). The results indicated that, in contrast to breast cancer, there was no strong association between HER-2/neu overexpression and gene amplification in invasive urothelial carcinomas, and polysomy 17 was higher in tumors showing HER-2/neu overexpression.     

Intranasal (transethmoidal) encephalomeningocele. Case report

Intranasal encephaloceles are rarely encountered in pediatric neurosurgery. The symptoms and clinical features may mimic those of nasal polyp. It is important to know the type of basal encephalomeningocele for appropriate surgical intervention. Computed tomographic examination is helpful for differential diagnosis of the encephalocele sac and localization of the cranial bone defect.     

Patients' awareness of their rights in a developing country

AIM: To determine the awareness of a regulation on patients' rights passed in 1998 in Turkey. METHODS: All hospitalized patients in the internal medicine and general surgery wards in three large hospitals during the study period were eligible for the study, which was performed in 2001 in the Denizli province, Turkey. The study group consisted of 166 patients. Data were collected during face-to-face interviews using a questionnaire. RESULTS: Only 9% of patients were aware of the regulation about patients' rights. Most patients were given equal access to health care (91%), benefitted from the capabilities of their selected healthcare institutions (86.7%), and their privacy was protected (86.1%). Those patients who stated that they had not received care in accordance with their rights identified the shortcomings as not receiving written (95.2%) or verbal (53%) information from healthcare professionals, and the failure of healthcare personnel to introduce themselves (75.3%). On most occasions, the patients stated that they were not able to request services as stated in the PRR from healthcare professionals. CONCLUSION: Few patients knew about the regulation on patients' rights, indicating a need for extensive education of patients and healthcare professionals.     

Three-dimensional ultrasound to assess the response to treatment in gynecological malignancies

OBJECTIVE: To report the potential role of 3D ultrasound to assess the response to treatment in gynecological malignancies. METHODS: The volumes and three 3D power Doppler indices are measured in one case of cervix carcinoma and in one case of ovarian carcinoma with primary radio- and/or chemotherapy before and after treatment. RESULTS: After treatment, tumor volume, vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) were reduced in both two cases. CONCLUSION: 3D ultrasound may provide a new method to assess the response to treatment in gynecological malignancies.     

The predictive value of echography in diabetic vitreous hemorrhage

PURPOSE: To identify echographic signs that are predictive for the prognosis of diabetic vitreous hemorrhage (VH). METHODS: Sixty eyes of 58 diabetic patients with VH were divided into two groups: group I contained 32 eyes with nonclearing diabetic VH which underwent pars plana vitrectomies. Group II contained 28 eyes which cleared spontaneously with time. The echographic signs were classified according to blood density, blood location and to the presence of vitreoretinal traction. RESULTS: The two groups showed statistically significant differences (P < 0.01) in the frequencies of the same echographic signs. In group I, a high or moderate density of blood in the vitreous cavity (71.5% of eyes), partial posterior vitreous detachment with one or more vitreoretinal or papillary traction sites (67.8%) and blood located in the vitreous gel (62.5%) were the main echographic signs associated with nonclearing diabetic VH. In group II, a low density of blood in the vitreous cavity (75%), total posterior vitreous detachment without a vitreoretinal or papillary traction site (68.8%) and blood in the subvitreal space (46.5%) were the main echographic signs associated with a diabetic VH that will clear with time. The presence of blood in both the vitreous gel and in the subvitreal space occurred at the same frequency (near 28%). CONCLUSIONS: Ultrasonographic examination of a diabetic VH can be predictive for the ultimate prognosis of the intraocular blood. The echographic signs found to be associated with spontaneous clearing of the hemorrhage are a low density of hemorrhage, complete vitreous detachment and blood in the subvitreal space.