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Piezogenic pedal papules are herniations of subcutaneous fat into the dermis. They are soft, skin-colored papules and nodules, which appear on the side of the heel when the subject is standing and disappear when weight is taken off the foot. Here, we present a 40-year-old male patient with mitral valve insufficiency and piezogenic pedal papules and discuss piezogenic pedal papules in the light of literature.

This article presents a review of the interventional radiological procedures in the percutaneous management of the bile duct stones through T-tube or transhepatic tracts. Interventional stone removal techniques mainly include extraction through the T-tube tract with baskets or forceps and expulsion into the duodenum by means of baskets or balloon catheters with the dilatation of the sphincter of Oddi. Fragmentation or size reduction of the stone, dilatation of the strictures and cholangioscopic assistance can facilitate the procedures. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

Power Doppler sonography (PDUS) is a promising technique for the diagnosis of renal infarcts. PDUS's efficacy may be enhanced by using sonographic contrast agents. We evaluated 3 cases of renal infarction using PDUS and the sonographic contrast agent Levovist. The findings were compared with those of other imaging modalities, such as scintigraphy, CT, and angiography. In case 1, PDUS showed a patent interlobar artery only in the lower part of the right kidney and no other perfusion of the right renal parenchyma. Contrast-enhanced PDUS showed patchy areas of preserved perfusion in the lower and middle-upper anterior portions of the kidney. In case 2, PDUS showed diffuse and patchy perfusion defects in the anterolateral portion of the right kidney. On contrast-enhanced PDUS, no signal enhancement was seen in these areas, but the perfusion defects were better delineated. In case 3, PDUS showed no perfusion in the upper pole of the kidney; the nonperfused area extended to the posterior upper portion of the kidney but could not be distinguished from normal tissue. After injection of the contrast agent, there was no enhancement of the posterior extension of the upper pole infarct, but Doppler signals from the surrounding normal parenchyma were enhanced, so the area was more clearly demarcated. The administration of the contrast agent facilitated the visualization of the infarcts in all 3 cases.

We aimed to describe the technical aspects and outcomes of the retrograde tibial approach and balloon predilation for recanalization of complex infrainguinal arterial occlusions and determine the efficacy of this approach in minimizing failure rates.Between September 2006 and April 2011, antegrade revascularization failed in 22 limbs with complex total occlusions within the infrainguinal arterial territory. For each of these antegrade failure cases in 22 patients, a retrograde tibial puncture had been attempted. Percutaneous recanalization and predilation were initially performed through tibial access, and final balloon dilatation or stent placement was performed from antegrade femoral access. The patients were followed up for functionality and wound healing.Access from the tibial artery was successfully obtained for all patients (100%). Successful recanalization was obtained in 18 patients (82%). Retrograde access was performed from the anterior tibial/dorsalis pedis artery in 12 patients and posterior tibial artery in 10 patients. One major and one minor complications were documented.Retrograde tibial recanalization technique in the infrainguinal complex arterial occlusion safely increases the success rates of percutaneous recanalization in the failed traditional approach and is a feasible endovascular option to avoid more invasive, time-consuming, and high-risk procedures.

This study retrospectively evaluated ultrasonography-guided (US-guided) percutaneous thrombin injection for the treatment of postcatheterization femoral and brachial artery pseudoaneurysms.Fifty-five patients with postcatheterization femoral artery (n = 53) or brachial artery (n = 2) pseudoaneurysms were treated using US-guided human thrombin (500 IU/mL) injection. Pseudoaneurysm size, thrombin dose, therapy outcome, and complications were documented. Follow-up color Doppler US was performed 7 and 30 days after treatment. Short-duration supplemental compression was applied to six patients at the first week follow-up examination after a reinjection of thrombin had failed.Mean pseudoaneurysm volume was 20.3 ± 18.7 cm(3). The mean injected thrombin dose was 478 ± 238 IU. Thirty-eight (69.1%) of the 55 pseudoaneurysms were thrombosed with a single injection, and 11 of 17 pseudoaneurysms were thrombosed after a second injection. All (100%) of the 41 pseudoaneurysms that were diagnosed within the first two weeks of postcatheterization were successfully treated. The overall primary success rate was 89.1% (49 of 55 pseudoaneurysms). Supplemental compression promoted thrombosis in four of the six patients who had treatment failure with thrombin injection. The secondary success rate was 96.4% (53 of 55 pseudoaneurysms). There were no complications.US-guided thrombin injection was most successful within the first two weeks, and the supplemental compression might aid in the closure of partially thrombosed pseudoaneurysms.

Cyanoacrylates (CAs) are a type of tissue adhesives which are currently the most commonly used for cutaneous closings. The use of CAs was reported in other clinical procedures such as odontology, neurological surgery, maxillary surgery, orthopaedics, plastic surgery, etc. In this experimental study the authors carried out posterolateral spinal fusion in a rat model to test the usefulness of ethyl-cyanoacrylate (ECA) in fixation of allograft/autograft fusions.25 Sprague-Dawley rats were randomized into two study groups. Bilateral posterolateral lumbar intertransverse process spinal fusion was performed with both autograft and allograft in both groups. ECA gel was dropped in the fusion area in a rat model in group II.The fusion rates as determined by manual palpation were 75% in controls and 46% in the ECA group (p = 0.322). According to radiographic score, the spinal segment was considered to be fused radiographically in 66% of controls and in 46% of animals in the ECA group (p = 0.43). The mean histological scores were 5.58 +/- 0.14 and 4.53 +/- 0.18 for the control and treatment group, respectively (p = 0.001). The mean bone density of the fusion masses was 101.3 +/- 2.5 in the control group and 92.0 +/- 3.3 in the ECA treatment group (p = 0.044).Ethyl-cyanoacrylate appeared to retard the osteogenic fusion but was well tolerated and did not induce necrosis, allergic reaction, infection, necrosis or neurological deficit in a rat model of posterolateral spinal fusion.

The aim of this prospective study was to assess the diagnostic benefit of taking a kidney-ureter-bladder (KUB) radiograph in an upright position during routine intravenous urography (IVU).Between February 2005 and September 2007, 170 consecutive patients were included in the study. A basal IVU exam consisted of pre-contrast supine KUB, post-contrast supine KUB at the 7th and 15th minutes, and supine pelvic radiographs with full bladder and post-voiding. When needed, additional compression and/or oblique radiographs were taken. In this study, for all patients, a post-contrast 15th minute upright KUB radiograph was added to IVU. Two consecutive radiographs taken at the 15th minute postcontrast in supine and upright positions were evaluated by consensus of 2 radiologists. Primary benefits were improved filling and emptying of the collecting system, and secondary benefits were nephroptosis and ascertaining diagnosis of phlebolith.Of 170 patients, 337 kidneys and collecting systems (n = 168 right; n = 169 left) were examined. Improved filling, emptying of the collecting system, nephroptosis, ascertaining diagnosis of phleboliths were detected with the rates of 12.5%, 44.2%, 8.3%, and 3.2%, respectively. Improved filling was significant in the presence of hydronephrosis (P0.05) and ureterolithiasis (P0.05) on both sides. There was a positive correlation between both improved filling and presence of hydronephrosis, and improved filling and presence of ureterolithiasis. Emptying was significant in collecting systems that had no visible pathology on IVU (P0.05) on either side.Upright KUB radiographs provide supplementary data about urine flow in terms of improved filling and emptying of the collecting system.

To evaluate the results of percutaneous transluminal angioplasty in the prevention of bypass graft failure with dilatation of the anastomotic and perianastomotic obstructions following surgery.Fourteen proximal or distal anastomotic/perianastomotic obstructions in one illiofemoral, one aortofemoral and ten femoropopliteal bypass grafts in eleven patients were diagnosed by clinical examination, Doppler ultrasonography, intravenous and intraarterial DSA in a follow-up period of 4-24 months after surgery. Percutaneous transluminal angioplasty was attempted in these anastomotic or perianastomotic lesions including two occlusions.Percutaneous transluminal angioplasty was successful for all cases. In a follow-up period of 4-45 months, eight patients remained asymptomatic with patient grafts. In one patient, the graft was occluded in the fourth month. In two others, restenosis occurred at the seventh and seventeenth months and required redilatation. Cumulative primary patency rate for one year was 92 +/- 6.8%.Percutaneous transluminal angioplasty is an effective alternative treatment modality for anastomotic and perianastomotic bypass graft-related obstructions and may enhance the overall graft patency.

Salivary duct carcinoma is a highly aggressive tumor characterized by an extensive cervical lymph node involvement, and distant metastasis. The majority of patients were male, and aged 50 years or older. Presenting symptoms have included a painful, rapidly enlarging, firm mass, usually associated with facial nerve paralysis. The treatment of salivary duct carcinoma is surgical. Total parotidectomy with neck dissection, and radiation therapy appear to be appropriate for local and regional control of this tumor. Despite aggressive treatment, prognosis is poor, with a frequency of distant metastasis ranging from 46% to 66% and a mortality rate of 60% to 75%. In this paper, we report the case of a 67 - year-old man with salivary duct carcinoma of the parotid gland. Both the differential diagnosis and the surgical treatment options are presented, and the literature is reviewed, Tükürük bezi duktal karsinomu yaygın servikal lenf nodu tutulumu ve uzak metastaz ile karakterize oldukça agresif bir tümördür. Hastaların büyük çoğunluğunu 50 yaş veya üzeri erkek olgularoluşturur. Genellikle fasiyal paralizinin eşlik ettiği, hızlı büyüyen, ağrılı sert bir kitle olarak ortaya çıkan duktal karsinomun tedavisi cerrahidir. Total parotidektomi, boyun diseksiyonu ve postoperatif radyoterapi bu tümörün lokal ve bölgesel kontrolünde uygun bir tedavi seçeneği olarak görülmektedir. Agresif tedaviye rağmen prognoz çok kötüdür. Uzak metastaz oranı % 46 ile % 66, ölüm oranı ise % 60 ile % 75 arasında değişmektedir. Bu yazıda 67 yaşında erkek hastada parotis bezi duktal karsinomu olgusu sunulmuştur. Hastalığın hem ayırıcı tanısı hem de cerrahi tedavi seçenekleri sunulmuş ve literatür gözden geçirilmiştir