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Arterial steal syndrome after orthotopic liver transplantation (OLT) is characterized by arterial hypoperfusion of the graft, which is caused by a shift in blood flow into the splenic or gastroduodenal arteries. In this report, we present mechanisms by which this syndrome caused ischemia in our patients. Steal was suspected by elevated levels of liver enzymes and the results of Doppler ultrasonography and computed tomographic angiography; it was confirmed by celiac angiography. Patients with established hepatic arterial thrombosis before angiography were excluded from this study. Steal was treated by embolization with a coil or by placement of an endoluminal narrowing stent. Ten patients at our institution (seven men and three women; mean age, 24.7 +/- 11 years; range, 6 to 40 years) exhibited biochemical evidence of liver ischemia and graft failure at 1 to 170 days after having undergone orthotopic liver transplantation. Nine of those patients had splenic steal, and one had both splenic and left gastric artery steal syndrome. None of the patients had gastroduodenal artery steal syndrome. The eight patients with splenic steal syndrome and the patient with both splenic and left gastric steal syndrome were treated by transcatheter occlusion with a coil. The remaining patient with splenic steal syndrome was treated with an endoluminal narrowing stent placement. All patients improved clinically within 24 hours after treatment, exhibiting significant changes in their biochemical and radiological parameters. Follow-up ranged from 1 to 22 months (mean, 6.7 +/- 6.6 months). One patient died from sepsis 1 month after having undergone coil embolization. He had no vascular anomalies at the time of death. We conclude that steal is a significant problem after OLT. Embolization and stenting are minimally invasive and successful treatments for steal, usually resulting early clinical improvement.

Hepatic artery stenosis (HAS) and thrombosis (HAT) after orthotopic liver transplantation remain significant causes of graft loss. Postoperative HAT follows approximately 5% to 19% of orthotopic liver transplantation. It is seen more frequently in pediatric patients. In the past, repeat transplantation was considered the first choice for therapy. Recently, interventional radiological techniques, such as thrombolysis, percutaneous transluminal angioplasty, or stent placement in the hepatic artery, have been suggested, but little data exist related to stent placement in the thrombosed hepatic artery during the early postoperative period in pediatric patients. Between March 2000 and March 2005, percutaneous endoluminal stent placement was performed in seven pediatric liver transplant patients. HAT or HAS initially diagnosed in all cases by Doppler ultrasound then confirmed angiographically. We intervened in four cases of hepatic artery stenosis and three cases of hepatic artery occlusion. Stents were placed in all patients. Three ruptures were seen during percutaneous transluminal angioplasty of the hepatic artery using a covered coronary stents on the first, fifth day, or 17th postoperative day. In one patient, dissection of the origin of the common hepatic artery developed owing to a guiding sheath, and a second stent was placed to cover the dissected segment. The other two hepatic artery stents remained patent. In one stent became occluded at 3 months after the intervention with no clinical problems. Follow-up ranged from 9 to 40 months. In conclusion, early and late postoperative stent placement in the graft hepatic artery was technically feasible.

Moyamoya syndrome is a rare cerebrovascular disorder characterized by bilateral progressive supraclinoidal stenosis or occlusion of the internal carotid artery and development of collateral vessels in the lenticulostriate region. The syndrome manifests itself in association with another disease or other clinical symptoms. We present the case of a 12-year-old girl with hemicentral retinal artery occlusion due to moyamoya syndrome associated with clinical and laboratory findings of presumed systemic lupus erythematosus.

Urologic complications, observed since the beginning of renal transplantation, cause significant morbidity and mortality. In the first few years the procedure was performed, incidence of urologic complications was reported to be 10% to 25%. Recently, the incidence of urologic complications after renal transplantation has decreased to 2.5% to 12.5%; unfortunately, a higher incidence exists in pediatric recipients, reaching approximately 20% with an associated 58% and 74% graft survival rates for cadaveric and living-related transplantation, respectively. We retrospectively analyzed the postoperative urologic complications reported in the medical charts of 1523 consecutive kidney transplantations (1130 men, 74.2%; 393 women, 25.8%; mean age, 31.9 +/- 10.9 years; range, 7 to 64 years; 354 cadaveric, 23.2%; 1169 living, 76.8%) performed by our team since 1975. The first 321 procedures took place at Hacettepe University Hospital in Ankara, Turkey, and the remaining 1202 were performed at Baskent University Hospital in Ankara. Urologic complications occurred in 46 (3%) recipients. Twenty-three (1.5%) of these patients had urine leakage, 15 (1%) had urinary obstruction due to ureteral stricture, 6 (0.4%) had distal ureter necrosis, and 2 (0.1%) developed renal calculi in the late postoperative period. Twenty-four out of 46 required reoperation for urologic complications. The remaining 22 patients were treated conservatively in our interventional radiology department with excellent results. In conclusion, urologic complications will always occur in the posttransplant period. Early diagnosis by experienced personnel and use of interventional radiology can greatly reduce the need for surgical treatment.

Purpose: To define the role of an antegrade occlusion balloon catheter in preventing migration of proximal ureteral stones to the dilated proximal ureter during endoscopic treatment. Material and Methods: An occlusion balloon catheter was used in 8 of 21 patients with proximal ureteral stones who underwent ureterorenoscopy. Five of the eight patients had solitary kidneys admitting with anuria and had percutaneous nephrostomy. In the other three patients, percutaneous nephrostomy and occlusion balloon catheters were placed a day before the procedure, since these patients had total obstruction and massive dilatation of the proximal ureter and renal collecting system. The balloons of occlusion catheters were inflated with 1 ml of sterile saline proximal to the stones just before ureterorenoscopy. Results: All stones could be reached by ureterorenoscopy and treated successfully with the aid of an ultrasonic lithotripter, and no stone migration to the upper dilated collecting system was observed. Just after the operation, while the patient was still lying on the operation table, the occlusion catheter was removed. The nephrostomy catheter was removed a day later. All patients were totally stone-free after the procedures. Conclusion: Occlusion balloon catheters increase the ureteroscopic treatment success rate in proximal ureter stones. This should be kept in mind especially when dilatation of the proximal collecting system is prominent and in cases with unsuccessful previous intervention with a retrograde stone cone catheter.

This study was designed to evaluate the frequency of contact sensitivity to 14 common preservatives among patients with contact dermatitis in Turkey. From 2000 to 2004, 308 patients with the diagnosis of contact dermatitis were patch tested in the Department of Dermatology, Ankara University School of Medicine. All patients were patch tested with European standard series. In addition to the four preservatives included in the standard series, patients were also tested with DMDM hydantoin, imidazolidinyl urea, bromonitropropane diol, diazolidinyl urea, thimerosal, propylene glycol, chlorocresol, chloroxylenol, methyldibromoglutaronitrile/phenoxyethanol (MDBGN/PE) and benzalkonium chloride. Out of the 308 patients suspected of having contact dermatitis, 23 patients were found to have positive reactions to one or more preservatives. Preservatives that were the most frequent cause of positive reactions were thimerosal (1.6%), benzalkonium chloride (1.6%), formaldehyde (1.3%) and MDBGN/PE (0.9%). In our study, 65% of the positive reactions were caused by allergens not present in the standard series, such as thimerosal, benzalkonium chloride and MDBGN/PE. Although thimerosal caused a high rate of contact sensitivity, it may not be considered as an important allergen, because clinical relevance could not be found in any of the patients.

Latex hypersensitivity manifests itself most commonly with contact urticaria. In this study, we investigated the frequency of latex hypersensitivity as a possible aetiological factor in patients with chronic urticaria (CU) and compared latex hypersensitivity of CU patients (n = 50) with that of rubber factory workers (n = 50) and healthy controls (n = 50). Prick test with latex and fruit extracts and determination of latex-specific immunoglobulin E (IgE) were performed. As a risk factor, contact dermatitis due to rubber additives was tested by patch test. Latex hypersensitivity was detected in 14% of CU patients, 12% of rubber factory workers and 12% of healthy controls (P > 0.05). Positive patch test with rubber additives was detected in 6% of CU and 4% of rubber factory workers. 3 of 7 CU patients had sensitivity to fruits in addition to latex hypersensitivity. In 1 patient with CU, the clinical complaints were found to be related to latex hypersensitivity. These findings suggest that the frequency of latex hypersensitivity in CU patients is no higher than that in healthy individuals. However, CU patients should be carefully asked about latex allergy, as we demonstrated that 1 of the CU patients had undiagnosed symptomatic latex allergy.

Background Behcet's disease is a multisystem disease featuring mucocutaneous, ocular, articular, vascular, intestinal, urogenital, and neurologic involvement and occurs with a high prevalence in the Mediterranean including Turkey. Higher incidence of severe clinical course and systemic involvement is observed in male patients. Objective To determine the influence of sex on the clinical course of Behcet’ s disease. Methods We retrospectively evaluated the clinical findings of 2313 Behcet patients followed up at the multidisciplinary Behcet's Disease Center at Ankara University. Results The male/female patient ratio was 1.03. Oral aphthae was seen in all patients. In male Behcet patients, the prevalence of mucocutaneous lesions and systemic manifestations was as follows: 85.6% genital aphthae, 45.5% erythema nodosum, 59.5% papulopustular lesions, 17.5% thrombophlebitis, 38.1% ocular involvement, 11.3% articular involvement, 11.7% vascular involvement, 3.3% neurologic involvement, 1.4% gastrointestinal involvement, and 1.8% pulmonary involvement. In female Behcet patients, the prevalence of manifestations were as follows: 91% genital aphthae, 49.8% erythema nodosum, 48.3% papulopustular lesions, 3.5% thrombophlebitis, 19.8% ocular involvement, 11.8% articular involvement, 2.1% vascular involvement, 1.3% neurologic involvement, 1.4% gastrointestinal involvement, and 0.03% pulmonary involvement. Conclusions Only genital aphthae and erythema nodosum were more frequent in females. On the other hand papulopustular eruptions, thrombophlebitis, ocular, neurologic, pulmonary and vascular involvement were more frequent in males. While female patients had the best prognosis, male patients had a worse overall prognosis than females.

Background: The feasibility and efficacy of portacaval shunt creation through the transhepatic and transjugular approach were evaluated in patients with portal hypertension whose hepatic venous anatomies were unsuitable for the standard shunt procedure. Methods: Portacaval shunts were created via percutaneous transhepatic access in six patients. We used snares to target the portal vein and the inferior vena cava. Then a needle was introduced percutaneously and advanced through the snares. A guidewire was advanced through the needle and snared in the inferior vena cava. The wire was then withdrawn through the transjugular sheath. The rest of the procedure was completed in standard fashion. The transhepatic tracts were embolized. Results: The portacaval shunt procedures were successful in all patients. There were no major complications during the procedures, but one patient died of sepsis 1 week later. Two patients developed shunt occlusion, and in one case the shunt was revised successfully. The other patient with occlusion underwent orthotopic liver transplantation. The shunts in the remaining three patients and the revised shunt were patent at 5 to 20 months of follow-up. Conclusion: Direct portacaval shunt creation using the percutaneous transhepatic and transjugular technique is a good alternative when standard portosystemic shunt creation is difficult or impossible.

CORRIGENDUM: Wireless control and selection of forces and torques - towards wireless engines

Powering and manipulating translational and rotational motions of objects wirelessly, and controlling several objects independently is of significant importance in numerous fields such as robotics, medicine, biology, fluid dynamics, optics. We propose a method based on coupled LC resonators, to control objects selectively by steering the frequency of an external magnetic field. This concept does not need any magnetic materials and it brings a rich variety of features concerning forces and torques. We theoretically and experimentally show that the forces can be enhanced by the interaction of resonators and that both direction and magnitude of forces can be controlled by the frequency of the applied external magnetic field. Moreover, we demonstrate interesting rotational effects, such as bi-directionally controllable torques, controllable stable orientations, and spinning, which leads to a wirelessly powered motor., Scientific Reports, 4, ISSN:2045-2322

Locoregional therapy may decrease the tumor stage and enable liver transplant in patients who have hepatocellular cancer. The purpose of the present study was to assess the relation between locoregional therapy and recurrence of hepatocellular carcinoma after transplant.In 50 patients who had liver transplant for treatment of end-stage liver disease from hepatocellular carcinoma and cirrhosis, outcomes were evaluated for associations with locoregional therapy before transplant and Milan criteria.Most patients had locoregional therapy before transplant (31 patients [62%]: transarterial catheter radiofrequency ablation alone, 16 patients; chemoembolization alone, 10 patients; both transarterial catheter radiofrequency ablation and chemoembolization, 5 patients). Follow-up at median 90 months after transplant showed that 9 patients (18%) had recurrence at median 45 months (range, 120 ± 12 mo) (recurrence: locoregional therapy, 5 of 31 patients [16%]; no locoregional therapy, 4 of 19 patients [21%]; not significant). Locoregional therapy was associated with a significantly lower frequency of recurrence in patients who were outside the Milan criteria.In patients who have liver transplant for treatment of hepatocellular carcinoma, preoperative locoregional therapy may decrease recurrence in patients who are outside the Milan criteria.

Surgical options for hepatocellular carcinoma must be considered first; if not, image-guided tumor ablation is recommended. The Barcelona Clinic Liver Cancer classification system is commonly used for patients with hepatocellular carcinoma. This classification system is important for image-guided tumor ablation. According to Barcelona Clinic Liver Cancer system, percutaneous tumor ablation is recommended for early stage hepatocellular carcinoma. Hepatocellular carcinoma nodules smaller than 2 cm, not subcapsular or perivascular, are ideal nodules for image-guided radiofrequency ablation. In patients with early hepatocellular carcinoma, the rate of complete response is approximately 97%, with a 68% of 5-year survival rate. Early stage hepatocellular carcinoma includes patients with preserved liver function (Child-Pugh score A or B), with solitary hepatocellular carcinoma, or up to 3 nodules less than 3 cm. it is important to the success of radiofrequency ablation to ablate all viable tumor cells and to create tumor-free margin. The best results are achieved if the tumor is less than 3 cm. If the tumor is between 3 and 5 cm, the success rate of radiofrequency ablation is decreased. Therefore, combination treatment has emerged for better results if the hepatocellular carcinoma nodule is larger than 3 cm and smaller than 5 cm. Radiofrequency ablation offers better survival than ethanol injection if the nodule larger than 2 cm. Microwave ablation can cause higher intratumoral temperatures, larger tumor ablation volumes, and faster ablation times. However, no statistically significant differences were observed between the two. A nonchemical and nonthermal image-guided ablation technique is irreversible electroporation. Irreversible electroporation causes irreversible disruption of the cell membrane integrity by changing the transmembrane potential. One advantage of this technique is complete ablation of the margin of the vessels. It can be applied to the nodules that is centrally located.

Objectives: We analyzed the efficacy of transforaminal epidural steroid injections under computed tomography (CT) in relieving lumbosacral radicular pain due to spinal stenosis.Methods: Forty-two patients (7 males, 35 females; mean age 67 years; range 34 to 90 years) with lumbosacral radicular pain due to spinal stenosis were prospectively monitored following transforaminal epidural steroid injections under computed tomography. Injections were repeated twice in two patients (4.8%) and three times in one patient (2.4%). The severity of pain was assessed with the use of a visual analog scale (VAS) before and after injections (1st day, 1st week, 3rd week, 6th month, and the last follow-up). The mean follow-up period was 12.1 months (range 6 to 25 months).Results: The median VAS score before injections was 9 (range 6 to 10). During the first six months, the median VAS scores were always significantly lower than the preinjection score (p, Amaç: Bilgisayarlı tomografi (BT) eşliğinde uygulanan transforaminal epidural steroid enjeksiyonlarının, spinal stenoza bağlı lumbosakral radiküler ağrısı olan hastalar üzerindeki etkinliği araştırıldı.Çalışma planı: Spinal stenoza bağlı lumbosakral radiküler ağrısı olan 42 hasta (7 erkek, 35 kadın; ort. yaş 67; dağılım 34-90) BT eşliğinde uygulanan transforaminal epidural steroid enjeksiyonu sonrası prospektif olarak izlendi. İşlem iki hastaya (%4.8) iki kez, bir hastaya (%2.4) ise üç kez uygulandı. Radiküler ağrının şiddeti işlem öncesinde ve işlem sonrası birinci gün, birinci hafta, üçüncü hafta, altıncı ay ve son kontrollerde görsel analog skala (GAS) ile değerlendirildi. Hastaların ortalama takip süresi 12.1 aydı (dağılım 6-25 ay).Sonuçlar: Tedavi öncesi ortanca GAS skoru 9 (dağılım 6-10) bulundu. İlk altı aylık takip sırasında ortanca GAS skorları, tüm değerlendirmelerde tedavi öncesine göre anlamlı derecede düşük bulundu (p

Introduction/Purpose: Intestinal Behcet’s disease may cause serious complications. Massive hemorrhage, fistulisation and intestinal perforation are encountered complications in approximately 50% of patients suffering from intestinal Behcet’s disease. Currently, there is not enough data inquiring iatrogenic ileocolonic perforation during colonoscopy in patients with intestinal Behcet’s disease; therefore we aimed to study intestinal Behcet’s disease patients who suffered perforation during or after colonoscopy. Methods: A total of 2615 colonoscopic examinations were performed between May 2002 and December 2007. Of these 2615 patients, main indication for colonoscopy was intestinal Behcet’s disease in 135 patients. Results: In total 135 patients with Behcet’s patients were assessed with colonoscopy due to presumed ileocolonic involvement. 8 out of 135 (5.9%) patients had ileal and colonic ulcers. 3 patients (2.22%) had iatrogenic perforation, 2 of whom had profound ulcers in proximal colon and ileum. The third case had ulcers in sigmoid colon, descending and transverse colon segments. All these 3 patients had undergone surgical intervention including ileal resection and right hemicolectomy. Discussion: Colonoscopic examination is commonly used in Behcet’s disease not only for diagnostic purposes but also for surveillance of intestinal involvement in Behcet’s disease. Volcano-shaped ulcers are specially inclined to perforate. Both clinicians and endoscopists should be alert against barotrauma applied during colonoscopy may cause perforation. Also patients should be followed-up necessarily and in case of abdominal pain after colonoscopic examination, colonic perforation should always be kept in mind.f

We report a case of giant, benign renal cyst that was treated with percutaneous aspiration and sclerotherapy using 95% alcohol. A seven French catheter was inserted into the cyst under ultrasonographic and fluoroscopic guidance, and was then left in place to drain the cyst contents. Approximately 4 l of fluid was drained the first day. The following day, a gravity sinogram was obtained, which showed there were no connections between the cyst and the collecting system. The alcohol treatment involved repeated injections of decreasing amounts of alcohol, with volumes selected in accordance with follow-up sinograms. The patient's symptoms resolved and cyst drainage stopped after 3 successive days of therapy. Totally 600 ml alcohol has given. Follow-up ultrasound (US) and computed tomography (CT) studies showed no recurrent disease; with only a small remnant of the cyst wall. We encountered no major complications during follow-up.

Epidermodysplasia verruciformis (EV) is an autosomal recessive disease characterized by the lifelong eruption of disseminated verrucae-like lesions. Numerous treatment modalities have been used to treat EV without benefit. Recently, retinoid and interferon therapies have been found to be of value in the treatment of EV. We present a case of EV that was treated with a combination of acitretin and interferon alfa-2a. (J Am Acad Dermatol 2001;45:296-9.)

Objectives After liver transplantation, biliary complications are more prevalent in pediatric patients, with reported rates varying between 15% and 30%. Methods We retrospectively analyzed biliary complications observed in 84 pediatric liver transplantation patients between July 2006 and September 2012. Biliary reconstruction was accomplished via a duct-to-duct anastomosis in 5 (83.3%) of the 6 patients receiving whole liver grafts and in 44 (56.4%) of the 78 patients who received a segmental live donor graft. For the remaining 34 patients with living donor and 1 patient with whole liver graft, Roux-en-Y hepaticojejunostomy was the preferred method. Results Post-transplantation biliary complications were encountered in 26 patients (30.1%). The biliary complication rate was 38% in 49 duct-to-duct anastomosis, whereas it was 20% in the hepaticojejunostomy group consisting of 35 recipients. Thirteen of the 18 biliary leaks were from duct-to-duct anastomoses and the remaining 5 were from the hepaticojejunostomies and 6 of the 8 biliary strictures were observed in recipients with duct-to-duct anastomosis. In 19 of the 26 patients, the biliary complications were successfully treated with interventional radiologic procedures and 1 was treated with stent placement during endoscopic retrograde cholangiopancreatography. Conclusions Percutaneous interventional procedures are valuable, effective, and life-saving therapeutic alternatives for the treatment of bile leaks and strictures after pediatric liver transplantations.

Background/Aim: Even though emollients are commonly used in combination with photochemotherapy, we still lack guidance for the selection of the appropriate emollient to be used in combination with photochemotherapy. The purpose of our study was to determine the interaction of commonly used emollients with photochemotherapy. Methods: The study was carried on 75 healthy volunteers. In order to assess the effects of five different emollients – white petrolatum, 3% salicylic acid in white petrolatum, Balmandol, Decubal and Urederm hydro – the subjects were divided into five groups. Minimal phototoxic dose (MPD) was determined by irradiating two rows of six circular test fields on the back of the subjects with increasing doses of UVA. One of the emollients listed above was applied to the skin under the upper rows alternatively, whereas the lower rows served as control. Results: Application of Urederm hydro and Decubal before exposure to UVA resulted in a statistically significant decrease in the MPD in all subjects. Even though application of white petrolatum and white petrolatum containing 3% salicylic acid decreased the MPD in most of the subjects and Balmandol application slightly increased the MPD, the results did not reach statistical significance. Conclusions: According to our findings, it is probable that the total dose of UVA needed to cause clearing of psoriasis would be decreased by application of Urederm hydro and Decubal prior to photochemotherapy. We noted a slight photoprotective effect of Balmandol in the UVA range, but this finding has to be further studied. Clinical studies are needed to clarify the effects of these emollients on the course and outcome of photochemotherapy.

Objective The aim of this study was to determine the effect of stressful life events on the onset and exacerbation of psoriasis, depression, anxiety, life satisfaction and affective expression levels in psoriasis patients and psychological risk factors related to psoriasis. Method Fifty psoriasis patients were examined dermatologically and psychiatrically and then administered the Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Scale (STAI I–II), Life Satisfaction Scale (LSS), Courtauld Emotional Control Scale (CECS) and Body Image Satisfaction Scale (BIS). Symptom severity was measured by the Psoriasis Area Severity Index (PASI). Results Thirty-four patients declared that they had had a psychologically stressful life event in the last 3 months prior to the beginning of the illness. The mean PASI score was 1.75 ± 1.65; BDI score 13.58 ± 6.11; STAI-I score 39.54 ± 9.18, STAI-II score 46.58 ± 8.05; LSS score 9.18 ± 4.39; CECS score 51.64 ± 9.75; BIS score 93.74 ± 16.67. Conclusion Psoriasis patients reported significantly higher degrees of depression and more body cathexis problems than controls. In addition, the risk for developing psoriasis increased significantly in patients with moderate and severe depression. We also found a relationship between symptom severity and low affective expression and high BDI scores in this study. These findings suggest that the relationship between psoriasis and psychological problems can be reciprocal and requires further investigation.

We evaluate the effectiveness of deep dorsal vein embolization for the treatment of venous impotence.A total of 32 impotent patients with veno-occlusive dysfunction underwent deep dorsal vein embolization. The condition was suspected based on findings of penile Doppler ultrasonography and cavernosometry. The diagnosis was confirmed with pharmacocavernosography that appeared to delineate venous leakage. During the procedure we isolated and cannulated the deep dorsal vein through a small dorsal penile incision with the patient under local anesthesia. We used a mixture of the tissue glue, N-butyl cyanoacrylate, and lipodol for embolization, with a total volume of 5 ml. injected antegrade into the previously catheterized dorsal vein under fluoroscopic control. As soon as we observed the occluded veins we performed repeat pharmacocavernosography. At 3-month followup patients were reassessed with history and cavernosometry. Followup ranged from 12 to 36 months (median 25).Of 32 patients 22 (68.7%) regained sexual activity, which was confirmed by cavernosometry. The remaining 10 patients (31.3%) experienced little if any clinical response, which correlated with cavernosometry. There were no significant side effects.Deep dorsal vein embolization for venogenic impotence is simple, effective and safe, and appears to be cost-effective. The results obtained in this limited number of patients are promising and justify trials in larger groups.

Background: Between May 1995 and April 1996, 20 patients with Behçet’s disease were successfully treated with interferon α2a (IFN-α2a) 9 million IU/day three times a week and 16 patients with colchicine 1.5 mg/day orally for 3 months. Objective: To study the long-term effects of IFN treatment in Behçet’s disease. Methods: Between the years of 1996 and 1999, the patients were followed up every 3 months or whenever indicated. Retrospective evaluation was performed. Results: In 56% of the patients with complete remission or partial remission at the end of IFN-α2a treatment, long-term remissions ranging from 36 to 48 months were observed. Conclusion: IFN-α2a treatment is an effective treatment modality in Behçet’s disease with the advantage of inducing prolonged remissions.

Purpose: To evaluate thoracic CT findings of long-term hemodialysis patients. Material and Methods: Thoracic CT findings of 117 uremic patients (61 men, 56 women) with complaints of cough, dyspnea, low-grade pyrexia, malaise, weight loss, and profuse perspiration were retrospectively documented. Results: Atelectasis (60%), cardiomegaly (60%), pleural effusion (51%), vascular congestion (44%), parenchymal consolidation (38%), parenchymal scarring-fibrosis (31%), and lymphadenopathy (29%) were the most common CT findings in the thoraces of the long-term hemodialysis patients. Staphylococcus aureus was detected in 13 patients (11%) who had parenchymal infiltration. Thoracic tuberculosis was identified in 15 patients (13%), 11 of these cases being confined to the lung parenchyma, 3 to the pleura, and 1 involving the pleura and pericardium. Conclusion: In patients under long-term hemodialysis treatment, parenchymal consolidation, secondary to infectious agents such as S. aureus and Mycobacterium tuberculosis, is the most important CT finding since these lesions can be detected and treated successfully if they are considered as etiologic factors early on.

A 67-year-old woman was admitted to our institution with pain, night cramping, and visible varicose veins on her left leg. Doppler ultrasonography revealed continuous reflux in the great saphenous vein when the patient did the Valsalva maneuver. Endovenous laser therapy was applied to the great saphenous vein. Doppler ultrasonography 7 days later showed recanalization of, and arterialized flow in, the great saphenous vein. There also were small arterial vessels adjunct to the recanalized side. A left femoral angiography via a right femoral approach showed multiple small arteriovenous fistulas between superficial femoral artery muscle branches and the great saphenous vein. A second endovenous laser treatment was done at 80 J/cm, but the recanalization persisted. We offered to treat this endovascularly, but the patient preferred a surgical option. To the best of our knowledge, this is the first report of the demonstration of such a complication with endovenous laser therapy.

Tracheobronchial stenosis in infants and small children is a frustrating lesion for both the pediatric surgeon and the patient and his or her family. Different surgical methods have been described to treat stenoses. Recently, tracheal stents have been introduced to relieve the airway obstruction in these patients. Here, we present 6 patients (2 newborns, 3 infants, and 1 three-year-old) with tracheal or bronchial obstructions treated with age-specific Palmaz balloon-expandable tracheal stents. One patient died due to sepsis. One patient's stent was removed successfully. No other problems occurred in the other 4 patients during 4 to 12 months of follow-up.

The aim of this study was to assess the impact of living-donor liver transplantation on the donor’s quality of life. Among the 48 performed at our hospital from October 2003 to June 2006, 46 (27 men, 19 women; mean age, 37.4 years) were followed for more than 4 months (mean, 16.5±8 months). In April 2006, these donors participated in a survey that included medical and psychosocial outcomes. Seven complications occurred in four of 46 donors (8.6%): two biliary leaks, two wound infections, one incisional hernia, one portal vein thrombosis, and one deep venous thrombosis. For the donor with portal vein thrombosis, the vein was recanalized, and she recovered without treatment; a bile leak from the cut liver surface and an incisional hernia also developed in the same donor. The biliary leak was treated with percutaneous drainage, and the incisional hernia was repaired surgically. Fifteen donors were housewives, 31 worked outside the home, and 94% returned to their work. A change in body image was reported in 4.3% of the donors. None reported impaired sexual function. Complete recovery occurred in 86% of donors, 94% of the donors said that they would donate again if necessary, and 97% believe that they had benefited from the donation experience. In conclusion, almost all donors were able to return to their prior jobs within a few months of surgery, and most donors were satisfied with the donation procedure.

A 35-yr-old woman, with acquired immunodeficiency syndrome, presented with right arm pain, erythema, and swelling. A lytic lesion of the ulna was found by radiograph. Ultrasonic and fluoroscopic guided fine-needle aspiration (FNA) yielded a neutrophilic and histiocytic exudate admixed with abundant long, bacillary forms that appeared as negative images on Papanicolaou stain and as very coarsely beaded acid-fast bacilli, resembling candy canes, on Kinyoun stain. These morphologic features permitted a preliminary diagnosis of mycobacteriosis, possibly of M. kansasii (MK) etiology. Appropriate therapy was initiated and resulted in not only marked symptomatic improvement of osteomyelitis and cellulitis, but resolution of chronic pulmonary infiltrates, presumed to be caused by fibrosis. Culture confirmed MK infection 3 wk after FNA. MK is one of the few mycobacteria that has a sufficiently characteristic morphology to permit presumptive diagnosis by smear. Culture, however, still remains the definitive method of speciation. Diagn. Cytopathol. 1998;19:94–97. © 1998 Wiley-Liss, Inc.

Following living-donor liver transplantation, biliary complications are more prevalent among pediatric patients (18 years old), with reported rates varying between 15% and 30%. In this study, we retrospectively analyzed biliary complications observed in 21 pediatric liver transplant patients (16 boys [76.2%], 5 girls [23.8%] of ages 1 to 18 years (mean, 8.3 +/- 5.05 years) between September 2001 and June 2004. Biliary reconstruction was accomplished via a duct-to-duct anastomosis in 12 (57.1%) and a Roux-en-Y hepaticojejunostomy in 9 (42.9%) patients. Postoperative biliary complications were encountered in six (28.5%) patients. Four of the biliary leaks were from a duct-to-duct anastomosis and two from an hepaticojejunostomy. One (4.7%) patient who experienced biliary leakage after a duct-to-duct anastomosis developed stenosis after the leak healed; five (23.8%) had the leakage treated successfully. One patient had biliary leakage from the duct-to-duct anastomosis subsequent to a hepatic artery thrombosis. All patients with biliary leakage were treated without surgery. Mean follow-up time was 10.2 +/- 9.6 months (range, 1 to 26 months). Three patients died during follow-up; however, these deaths were not related to the biliary complications. Interventional radiologic approaches are effective to biliary complications, even when the anastomoses are heavily disrupted. In cases of biliary complication, percutaneous combined with internal drainage may prevent biliary sepsis and provide long-term patency.

Strongyloides stercoralis is endemic in the tropical and subtropical areas of the world. It is a soil-transmitted intestinal nematode affecting anywhere from 30 to 100 million people worldwide. Strongyloides stercoralis is capable of causing autoinfection, which increases larval migration and proliferation in the host. This condition may lead to hyperinfection syndrome which has the potential to cause serious life threatening complications, especially in immunosuppressed patients. Thus, Strongyloides stercoralis hyperinfection syndrome should be suspected if there are clinical clues including gastrointestinal tract symptoms (abdominal pain, nausea, vomiting, diarrhoea), respiratory tract symptoms (cough, dyspnoea, wheezing, haemoptysis), skin symptoms (pruritus, erythema) and peripheral eosinophilia in a patient with underlying risk factors. Herein, we report a case of Strongyloides stercoralis hyperinfection syndrome in a patient with Behçet's Disease on immunosuppressive treatment.

Amaç: Topikal ilaçlar kontakt allerjenler arasında önemli bir gruptur. Çalışmamızda, kontakt dermatitli olgularda topikal ilaçlara bağlı kontakt duyarlılığın değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: 2003 ve 2008 yılları arasında Ankara Üniversitesi Tıp Fakültesi Dermatoloji Anabilim Dalı’nda topikal ilaç kullanımına bağlı kontakt dermatit geliştiğinden şüphelenilen 129 hasta çalışmaya alındı. Çalışmada Avrupa standart yama testi serisi ve Medikament yama testi serisi ve hastaların kullanmış olduğu topikal ilaçlarla yapılan test sonuçları değerlendirmeye alındı. Test sonuçlarının klinik tablo ile uyumluluğu değerlendirildi. Bulgular: Çalışmaya alınan 129 hastanın 80’inde (%62,0) bir veya birden fazla allerjene karşı pozitiflik saptandı. Pozitiflik saptanan 80 hastanın 61’inde (61/129, %47,3) medikament pozitifliği olduğu görüldü. Klinik olarak anlamlı medikament duyarlılık sıklığı %37,9 (49/129) olarak saptandı. Nitrofurazon (%18,6) en sık allerjen olarak saptandı. Sonuç: Çalışmamızda topikal olarak uygulanan ilaçlara karşı allerjik kontakt dermatit gelişiminin sık görüldüğü saptanmıştır. Bu nedenle kontakt dermatit şüphesi ile değerlendirilen hastalarda topikal ilaçlara bağlı kontakt duyarlılık ihtimali akılda tutulmalı ve gerekli durumlarda sorumlu antijenin saptanması amacıyla yama testleri ile ileri araştırmalar yapılmalıdır., Background and Design: Topical drugs are an important group of contact allergens. The present study aimed to evaluate contact sensitivity to topical drugs in patients with contact dermatitis. Materials and Methods: Between 2003 and 2008, 129 patients were followed up at the Department of Dermatology at Ankara University School of Medicine with clinically suspected contact sensitivity to topical drugs. In this study, the patch test reactions to the European Standard Battery and topical drugs used by the patients and medicament patch test results were evaluated. Results: Positive patch test reaction to one or more allergens was found in 80 (62.0%) of 129 patients included in the study. Sixty-one of the 80 patients (61/129, 47.3%) had positive patch test reaction to medicaments. Medicament sensitivity was detected in 37.9% (49/129) of subjects. Nitrofurazone was found to be the most common allergen (18.6%). Discussion: The present study showed that topical drugs are a frequent cause of allergic contact dermatitis. Therefore, the probability of contact sensitivity to topical drugs should also be considered in patients with the clinical diagnosis of allergic contact dermatitis and, suspected cases should be evaluated further with patch testing in order to find the responsible allergens.

The purpose of this prospective study was to define the enhancement pattern of the facial nerve in idiopathic facial paralysis (Bell's palsy) on magnetic resonance (MR) imaging with routine doses of gadolinium-DTPA (0.1 mmol/kg). Using 0.5T imager, 24 patients were examined with a mean interval time of 13.7 days between the onset of symptoms and the MR examination. Contralateral asymptomatic facial nerves constituted the control group and five of the normal facial nerves (20.8%) showed enhancement confined to the geniculate ganglion. Hence, contrast enhancement limited to the geniculate ganglion in the abnormal facial nerve (3 of 24) was referred to as equivocal. Not encountered in any of the normal facial nerves, enhancement of other segments alone or associated with geniculate ganglion enhancement was considered to be abnormal and noted in 70.8% of the symptomatic facial nerves. The most frequently enhancing segments were the geniculate ganglion and the distal intracanalicular segment.

Wir berichten uber einen 32jahrigen Patienten mit fortgeschrittenem, erworbenen Immundefizienz-Syndrom (AIDS), bei dem eine schwere gastrointestinale Kandidose festgestellt wurde. Initial erfolgte eine Behandlung mit Fluconazol 200 mg/d uber5 Monate, die dann mit Itraconazol 200 mg/d uber einen weiteren Monat kombiniert wurde. Die Kandidose zeigte sich klinisch resistent auf beide Azol-Antimykotika. Die antimykotische Aktivitat von Fluconazol, Itraconazol und auch von Ketoconazol gegen Candida albicans wurde in vitro mit dem Mikrodilutionstest durch Bestimmung der 90%-Hemmkonzentration ermittelt. Eine hohe minimale Hemmkonzentration (MHK) wurde fur Fluconazol (50 μg/ml) festgestellt gleichbedeutend mit einer Fluconazol-Resistenz. Die Empfindlichkeit war gegen Itraconazol grenzwertig (MHK 0,125 μg/ml) und gegen Ketoconazol deutlich erniedrigt (MHK 0,25 μg/ml). Im Blutplasma lies sich daruber hinaus ein erniedrigter Itraconazol-Spiegel nachweisen. Bei HIV-Patienten ist die gastrointestinale Absorption von Azol-Derivaten haufig vermindert, so das sich die klinische Resistenz von Itraconazol, neben einer grenzwertig erniedrigten Empfindlichkeit von Candida albicans, auch durch eine reduzierte Absorption erklaren last.