A CHILD WITH UNDIFFERENTIATED SARCOMA OF THE LIVER COMPLICATED WITH BRONCHOBILIARY FISTULA AND DETECTED BY HEPATOBILIARY SCINTIGRAPHY

Undifferentiated (embryonal) sarcoma of the liver (USL) is a rare malignant mesenchymal tumor principally affecting patients of pediatric age. Bronchobiliary fistula is a very rare complication in patients with liver tumor. To the authors' knowledge, this is the first report of a bronchobiliary fistula resulting from tumor invasion in a child with liver sarcoma. A 12-year-old boy was diagnosed to have USL of the right liver lobe, invading the diaphragm. An extended right hepatectomy and total resection of the mass was performed, leaving patchy tumoral invasion of the anterior diaphragmatic surface followed by combined chemotherapy regimen. Six months after the operation, the presence of bilious sputum suggested a bronchobiliary fistula, which was confirmed by hepatobiliary scintigraphy. The patient underwent a right thoracotomy and fistula division. Although bronchobiliary fistula is a very rare complication in patients with hepatic tumors, suspicion in the appropriate clinical setting is necessary to recognize this problem. Hepatobiliary scintigraphy is the useful diagnostic procedure to define bronchobiliary fistula in children with liver tumor and clinical suspicion of bronchobiliary fistula.     

The development and psychometric evaluation of a support scale for pre-school inclusion

This study aimed to develop a new scale, the 'Supports Scale For Preschool Inclusion' (SSPI), to assess pre-school teachers' perceptions of necessary factors and availability of supports for a successful inclusion in pre-school educational settings. Pre-school teachers (n = 183, mean age = 32.81, standard deviation = 8.29) from all regions of Turkey participated in the study. They were asked to fill in each item of the SSPI for two dimensions, namely necessity and support dimensions, by rating on a four-point Likert-type scale from 1 (none) to 4 (completely). A number of reliability and validity analyses—such as internal consistency, test-retest reliabilities and factor and criterion validities—were conducted to examine the psychometric properties of the SSPI. The results showed that the 34-item respondent-based scale is a reliable and valid instrument to assess pre-school teachers' perception of necessities and availabilities of supports for successful inclusion. Findings were discussed in relation to the usage of the scale in inclusive settings.     

Malignant pleomorphic adenoma (malignant mixed tumor) of the trachea: a case report and review of the literature

A case of malignant mixed tumor of the trachea in a 56-year-old man is described. His tumor was removed by segmental tracheal resection, and end-to-end anastomosis was performed. Histologically, the tumor was characterized by a biphasic composition showing admixtures of epithelial elements in varying proportions; these were cytologically atypical with prominent mitotic figures. However, stromal elements were osteoid and mixoid with a benign appearance. The patient had no evidence of disease in the head and neck region and had no history of previous surgery for a salivary gland tumor. These findings were interpreted as indicative of malignant pleomorphic adenoma of the trachea.     

The role of antibiotic treatment alone for the management of Brucella endocarditis in adults: a case report and literature review.

Endocarditis is a rare complication of brucellosis but it is the main cause of the mortality in this disease. The accepted treatment for Brucella endocarditis (BE) is a combination of valve replacement and antibiotics. Conservative antibiotic treatment alone is not recommended by most of the authors as it is considered ineffective and increase the risk of fatality. In our literature search, we found 14 adult patients with BE treated only with antibiotics with a favorable outcome. In this report, we described a patient treated with antibiotics alone and reviewed the literature. Depending on the data from the growing literature and our patient we suggest that in selected patients with BE who do not have congestive heart failure, valvular destruction, abscess formation, or a prosthetic valve, conservative antibiotic treatment may be a valid alternative to surgery.     

Clinical findings in the renal victims of a catastrophic disaster: the Marmara earthquake.

BACKGROUND: The clinical course of acute renal failure (ARF) related to crush syndrome is very complex, because of co-existing surgical and/or medical complications. After the devastating Marmara earthquake that struck Turkey in August 1999, 639 patients were identified with nephrological problems, whose clinical findings have been the subject of this analysis. METHODS: Specific questionnaires asking about 63 variables were sent to 35 reference hospitals that treated the victims. Clinical findings of the renal victims were analysed. RESULTS: At admission, high fever was noted in 31.8% of the patients; the temperature of non-survivors was higher (P=0.027). Mean blood pressure was higher in survivors (P=0.004) and dialysed victims (P <0.001). Most (61.4%) patients were oligo-anuric; oliguria lasted for 10.8+/-7.2 days. Thoracic and abdominal traumas were associated with a higher risk of mortality. 397 fasciotomies and 121 amputations were performed in 790 traumatized extremities. Fasciotomies were associated with sepsis (P<0.001) and dialysis needs (P<0.0001), while amputations were associated with mortality (P<0.0001). Medical complications, which were associated with dialysis needs (P<0.0001) and mortality (P<0.0001), were observed in 51.5% of patients. In a multivariate analysis model of medical complications, disseminated intravascular coagulation (DIC) (P<0.0001, OR=5.81), and adult respiratory distress syndrome (ARDS) (P=0.0001, OR=4.53) were predictors of mortality. CONCLUSIONS: In the aftermath of catastrophic earthquakes, clinical findings of the renal victims can predict the final outcome. While fasciotomies indicate dialysis needs, extremity amputations, abdominal and thoracic traumas are associated with higher rates of mortality in addition to DIC and ARDS.     

Right ventricle-dependent coronary circulation demonstrated with 64-slice computed tomography

A 12-year-old female patient, who had emergency left modifiedBlalock–Taussig shunt operation during neonate and a totalcavo-pulmonary shunt operation performed at the age of