Takayasu's arteritis(arteritis syndrome) is an inflammatory disease process affecting primarily the aorta and its main branches. It's etiology and pathogenesis are unknown. Controversy exists in treatment. Segmental stenoses, occlusions, and aneurysmal degeneration of the aorta and the proximal arterial tree are frequent findings. Clinical presentations may include cerebrovascular ischemia, limb ischemia, aortic valvular insufficiency, heart failure, renovascular hypertension, or renal failure. Recently, we experienced a case of Takayasu's arteritis in a 24 years old female with severe dizziness, claudication in right upper extremity. Patient was treated by angioplasty of left vertebral artery and concomitant left subclavian-to-right axillary artery bypass surgery followed by percutaneous transluminal angioplasty with stent therapy of right vertebral artery to prevent cerebrovascular ischemia during the operation. Postoperative result was excellent and dizziness and claudication of right arm were completely relieved.
Aneurysm ; Angioplasty ; Aorta ; Arm ; Axillary Artery ; Constriction, Pathologic ; Dizziness ; Extremities ; Female ; Heart Failure ; Humans ; Hypertension, Renovascular ; Ischemia ; Renal Insufficiency ; Stents ; Takayasu Arteritis* ; Upper Extremity ; Vertebral Artery* ; Young Adult

No abstract available.
Alcoholism* ; Diagnosis*

No abstract available.

BACKGROUND: Antibiotics are used prophylactically in surgery to prevent postoperative infection. However, antibiotics administered in large doses can cause a bleeding diathesis as a result of platelet dysfunction. We wondered whether these antibiotics might impair platelet function by interfering with the initial step of platelet activation: the binding of agonists to their specific receptors on the platelet surface. METHODS: In 30 patients (male 18, women 12) undergoing primary elective knee arthroscopic surgery, the whole blood coagulation system was prospectively evaluated before, and 10 and 40 minutes after administration of 1 g of augmentin. All patients who had abnormal preoperative coagulation profiles or who received anticoagulant or antiplatelet, antibiotics therapy within 7 days prior to surgery were precluded. RESULTS: At 10 minutes after augmentin administration 25 of 30 patients had a significant impairment in all phases of whole blood coagulation as monitored by thromboelastography. In contrast, three of 30 patients had a significantly decreased coagulation time. Two of 30 patients had no significant changes of TEG variables. TEG variables were restored toward baseline in fourty minutes after augmentin administration. CONCLUSIONS: Augmentin can cause a significant but transient change in the viscoelastic properties of blood. Coagulation parameters of the TEG should be measured prior to augmentin administration to prevent and prospect a bleeding diathesis as a result of platelet dysfunction.
Amoxicillin-Potassium Clavulanate Combination ; Anti-Bacterial Agents ; Arthroscopy ; Blood Coagulation ; Blood Platelets ; Disease Susceptibility ; Female ; Hemorrhage ; Humans ; Knee ; Platelet Activation ; Prospective Studies ; Thrombelastography*

PURPOSE: To evaluate CT findings of internal hernia. MATERIALS AND METHODS: Three patients with internal hernia had abdominal CT scans and two of them had small bowel follow through examinations. The CT features of two patients with retroanastomotic and one patient with left paraduodenal hernia were evaluated and correlated with small bowel follow through examinations, and surgical findings. Two patients with retroanastomotic hernia had a history of subtotal gastrectomy with antecolic gastrojejunostomy. The diagnosis of internal hernia was made on the basis of surgical find ings in two patients of retroanastomotic hernia, and characteristic barium study findings in one patient of left paraduodenal hernia. RESULTS: The small bowel follow through examination showed small bowel loops gathered in a circumscribed mass in the left mid abdomen, and delay in passage through these loops. In case of left paraduodenal hernia, abrupt narrowing of the distal duodenum could be identified. The characteristic CT findings of all three patients were whorling of the mesentery and mesenteric vessels in the left mid-abdomen. In the patient with left paraduodenal hernia, after resolution of the gastrointestinal symptoms, a follow-up CT scan showed spontaneous disappearance of whorling of the mesentery and mesenteric vessels suggesting spontaneous resolution of the hernia. In the other two cases, upon exploration of the abdomen, dilatation of afferent duodenum caused by adhesion between ligament of Treitz and adjacent bowel walls, and retro- anastomotic herniation of the efferent loops were found. CONCLUSION: The usual diagnosis of internal hernia is based on the appearance of the small bowel follow through examination. However, we consider that the whorling appearance(we call it whorling sign) of the mesentery and mesenteric vessels on CT scan is also suggestive of internal hernia in patients under clinical suspicion.
Abdomen ; Barium ; Diagnosis ; Dilatation ; Duodenum ; Follow-Up Studies ; Gastrectomy ; Gastric Bypass ; Hernia ; Humans ; Ligaments ; Mesentery* ; Tomography, X-Ray Computed

PURPOSE: To evaluate the radiologic findings of alimentary anthrax. MATERIALS AND METHODS: 19 patients with alimentary anthrax, which was caused by ingestion of contaminated beef, were included in this study. The diagnosis was made .b.y demonstration of Bacillus anthracis in smear and culture of the contaminated meat. We evaluated the clinical manifestations and the findings of thoracic, abdominal radiographs, cervical, abdominal ultrasonograms and abdominal CT scans. RESULTS: Out of the 19 patients with the alimentary infection, 9 had oropharyngeal form, 18 had abdominal form and 8 had combination of oropharyngeal and abdominal form. The patients had general symptoms and signs such as fever, chill, myalgia. Clinical symptoms and signs were sore throat, throat injection, throat ulcer and patch in oropharyngeal form, and nausea, vomiting, abdominal pain, diarrhea, and gross GI bleeding in abdominal form. Radiologic findings included enlarged cervical lymph nodes(36%) in oropharyngeal form, and paralytic ileus(26%), ascites(26%), hepatomegaly(21%), enlarged mesenteric lymph nodes(26%), small bowel wall thickening(5%) in abdominal form. In two patients, late complications occurred as intestinal obstruction due to ileal stricture with perforation, and inflammatory changes of pelvic cavity due to ileovesical fistula. CONCLUSION: Radiologic findings of alimentary anthrax are difficult in differentiation from those of other inflammatory bowel disease, but those radiologic findings with clinical manifestations may be helpful in diagnosis and evaluation of disease process in patients with alimentary anthrax.
Abdominal Pain ; Anthrax* ; Bacillus anthracis ; Constriction, Pathologic ; Diagnosis ; Diarrhea ; Eating ; Fever ; Fistula ; Hemorrhage ; Humans ; Inflammatory Bowel Diseases ; Intestinal Obstruction ; Meat ; Myalgia ; Nausea ; Pharyngitis ; Pharynx ; Tomography, X-Ray Computed ; Ulcer ; Ultrasonography ; Vomiting

PURPOSE: The purpose of this study was to evaluate the patency, procedure related complications and effectiveness of Wallstent application to the malignant biliary obstruction as a palliative treatment. MATERIALS AND METHODS: We retrospectively reviewed the clinical results, duration of survival, patency rate and complication of the Wallstent application on 33 patients who had had obstructive jaundice by the malignant lesion in recent 3 years. One or two step procedures. were mainly taken with 10mm diameter Wallstents. Grouping according to place the stent at the hilum or not, and grouping according to place the stent through the ampulla or not were done to evaluate the difference of the patency and survival rate between the groups. RESULTS: Biliary endoprosthesis with Wallstent were successfully placed in all patients without difficulty. Procedure related short-term complication rate was about 18.1% (n=6/33). Complications were fever(n=4), cholecystitis(n=1) and sepsis(n=l). Long-term complications were mainly obstruction(n=9/31) of the Wallstent during the follow-up period. Also cholecystitis occurred in one patient 3 months later. Mean survival duration was 139.72 (46-237)days ormong those who expired. Mean patency duration of stents was 139.67 (26-310) days. Survival rates were 93.5% at the second month, 68.8% at the third month, 61.2% at the 4th month, 53.5% at the 5th month, 49.1% at the 7th month and 35.7% at the 9th month. Patency rates were 93.7% at the second month, 84.2% at the 4th month, 66.9% at the 5th month, 59.5% at the 7th month and 39.6% at the 10th month. The application was repeated in the 6 patients with stent occlusion. Significant statistical difference could not be found between the groups according to placing the stent at the hilum and according to placing the stent through the ampulla. Patency rates were higher than survival rates in the follow-up period. CONCLUSION: Wallstent application provides good palliation with little discomfort and few complications in the patients with malignant obstructive jaundice.
Cholecystitis ; Follow-Up Studies ; Humans ; Jaundice, Obstructive ; Palliative Care ; Retrospective Studies ; Stents ; Survival Rate

Combined spinal epidural block with use of the needle-through-needle technique has become increasingly more popular during recent years because it provides rapidity and density of spinal block, combined with the ability to extend the block and provide postoperative analgesia by use of the extradural catheter. However, the combined spinal epidural block has some disadvantages. Since the spinal needle makes a hole in the dura, the accidental migration of an extradural catheter into the dural opening made previously by the spinal needle is thought to be theoretical risk. We report a case during combined spinal epidural anesthesia for a total hip replacement in which the clear fluid in the epidural catheter was found and tested to confirm the nature of fluid and migration of catheter by the dextrostix test and the immunoelectrophoresis test(prealbumin test).
Analgesia ; Anesthesia, Epidural* ; Anesthetics, Local* ; Arthroplasty, Replacement, Hip ; Catheters ; Immunoelectrophoresis ; Needles

No abstract available.
Femur* ; Osteosarcoma*

BACKGROUND: The overall prognosis of acute leukemia has dramatically improved in the past 20 years, primarily due to the use of intensive multiagent chemotherapy in combination with CNS prophylaxis. However, increased aggressiveness of treatment protocols was entailed a great risk of various toxic effects. Endocrine function was also affected. The aim of this study is to compare the effect of chemotherapy on thyroid function in children with acute leukemia. METHOD: Parameters of thyroid function during chemotherapy were measured in 11 children with acute leukemia. Level of the serum 73,74 and TSH were determined before therapy, 7th day and 30th day of chemotherapy. Determination of serum 73, 74 and TSH were performed by conventional radioimmunoassay technique. Statistical analysis was done using SAS software. RESULT: 1) Level of level 73 was normal in 7 cases before therapy and decreased in 9 cases on 7th day of remission induction therapy. On 30th day, 73 level was increased to normal value. 2) Level of 74 was normal before therapy and decreased on 7th day of therapy. On 30th day of therapy 74 level showed various change. Three of them showed sustained low level of 74 on 7th and 30th day. 3) Level of TSH were normal before therapy and decreased on 7th day of therapy, followed achievement of normal level after completion of induction therapy. CONCLUSION: We conclude that during induction chemotherapy in childhood acute leukemia, thyroid function was impaired which was reversible.
Child ; Clinical Protocols ; Drug Therapy* ; Humans ; Induction Chemotherapy ; Leukemia* ; Prognosis ; Radioimmunoassay ; Reference Values ; Remission Induction ; Thyroid Gland*