The problems and advantages of one lung ventilation during surgical intervention in pulmonary hydatid cyst disease

Background Hydatid disease is the most severe helminthic zoonosis, with an important public health problem especially in rural areas in Turkey. The aim of this study was to review the problems and advantages encountered in surgical treatment of 43 patients who were ventilated with one-lung ventilation during last four years. Methods Patients, operated with one-lung ventilation, constitute the study group. Data related to symptoms, radiographic findings, performed surgical procedures, perioperative and postoperative morbidity, hospitalization time, and cyst recurrence were collected from each individual's records. Results Cystotomy and capitonnage were performed in all cases. Perioperative complications were seen in 5 patients. Four of these 5 patients had double-lumen endotracheal tube malpositioning. In one patient hypoxemia developed. The most common postoperative complication was atelectasis. One patient had recurrent cysts. There was no perioperative or postoperative death. Conclusions We prefer cystotomy and capitonnage because it is a fast and effective technique with limited postoperative complications. One-lung ventilation prevents the exposure of lower lung areas from massive aspiration, which may cause acute obstruction of airways, and contamination by cyst contents from the operative part of the lung that causes recurrent disease. One-lung ventilation in pulmonary hydatid cyst surgery may be preferred owing to lower mortality and morbidity rates.     

Thermal and cold neutron phase-contrast radiography.

In this paper, we will discuss a phase-contrast imaging method that avoids the complications of interferometry to provide phase contrast in weakly absorbing samples. A transversely coherent neutron beam is used with the traditional radiography scheme. Images taken with this scheme show dramatic intensity variations due to sharp changes in the neutron wave refractive index. With some numerical processing these images may be used to reconstruct a quantitative phase radiograph of specimens imaged with this technique.     

High prevalence of and risk factors for hepatitis C in haemodialysis patients in Saudi Arabia: a need for new dialysis strategies

Non-A, non-B is a major form of hepatitis in haemodialysis (HD)patients. Hepatitis C virus (HCV) has been recently identifiedas the leading cause of non-A, non-B hepatitis in HD. A variableprevalence of hepatitis in HD has appeared in the literature,ranging between 1% and 29% in the Western world, and between30% and 54% in Saudi Arabia, but all these reports used first-generationELISA. Using second-generation enzyme immunoassay, we conducteda multi-centre study involving 22 HD centres all over SaudiArabia in order to establish the prevalence and risk factorsfor HCV in HD patients in Saudi Arabia. A total of 1147 patientswere studied, with a mean age of 43.4±15.3 years. Fivehundred and eighty were males and 567 were females. The overallprevalence rate of positive anti-HCV was 68%, with a range fromas low as 14.5%, to 94.7%. To our knowledge, this is the highestvalue reported among dialysis patients world-wide. A positivecorrelation was found between anti-HCV positivity and male sex(P=0.005), longer duration on dialysis (P=0.002) and blood transfusion(P=0.003). However, interestingly 62.6% of the patients whohad not had blood transfusion had anti-HCV antibodies. HCV antibodieswere also found more frequently in Egyptians, Pakistanis andYemenis than in Saudis. A comparison between those centres withlow prevalence of positive HCV and those with high prevalenceregarding risk factors was carried out, and it was found thatthe major difference between them was the adherence of the staffto universal infection precautions. In conclusion, HCV is amajor health problem in HD patients in Saudi Arabia. Identifiablerisk factors are longer duration in dialysis, blood transfusion,male sex, nationality and most importantly the lack of adherenceto universal infection precautions.     

Delayed Reduction of Irreducible Chronic Posterolateral Dislocation of the Knee with Buttonholing of the Medial Femoral Condyle

Abstract Traumatic knee dislocations are relatively rare and almost always respond to closed reduction; however, a small percentage of knee dislocations are irreducible and in these cases open reduction is frequently required. A 65-year-old man with an unreduced posterolateral knee dislocation with laterally dislocated patella was seen 3 weeks after a motor vehicle accident. Medial femoral condyle was found buttonholed through the medial capsule together with the medial collateral ligament and lying in the medial joint space that allowed posterior rotary dislocation of the joint. Both cruciate ligaments and medial meniscus were torn. There was no evidence of any vascular or nerve injury. Reduction was accomplished by removal of the capsuloligamentous structures which were incarcerated in the trochlea and intercondylar notch and by excision of meniscal tear. Following posterior cruciate ligament reconstruction with patellar tendon autograft, lateral patellar release, vastus medialis advancement, and gracilis transfer were done.