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Tuberculous pseudoaneurysm of the aorta is a rare disease that is uniformly fatal if not treated properly. The authors present a case of a recurrent tuberculous false aneurysm of the descending thoracic aorta that was treated surgically with excision and primary repair of the lesion. To their knowledge, this is the first reported case of recurrent disease after a successful surgical treatment. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine opinions of medical residents undergoing anaesthesia and reanimation training about equipment, programmes, applications, study conditions and shift systems at training institutions in Turkey., Methods: A web-based survey was sent by e-mail to residents in anaesthesiology and reanimation training programmes. The survey comprised 73 questions about demographic characteristics, satisfaction, basic specialisation knowledge, anxiety and motivation., Results: The study included 270 individuals. Of the residents, 82.2% willingly chose their field, whereas 66.7% stated that specialisation was necessary because of incorrect application of first-stage and GP medical services. The mean of the weekly working hours was 91.69±36.69 hours; the mean number of monthly on-call shifts was 7.49±1.99. Of the participants, 61.9% found the predicted five-year training duration long. The intensive care training duration was sufficient for 71.1% and only 26.3% found the pain management training duration sufficient., Conclusion: According to the results, the number of residents is insufficient, workload is heavy, working hours are long and large numbers of shifts are worked without leave afterwards. In spite of negatives and high dissatisfaction, most residents willingly chose their departments and would choose the same branches again. Participants stated that their institutions emphasised service rather than education and research, and educators were less accessible to residents due to increasing service loads., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (© Copyright 2019 by Turkish Anaesthesiology and Intensive Care Society.)

Radical pleurectomy/decortication was performed in a patient with malignant pleural mesothelioma. During the surgery, the left subclavian artery was injured, and repaired via resection and anastomosis. However, the patient was diagnosed with paraplegia following extubation. After deliberate investigations, the mechanism of injury to the critical vascular zone of the spinal cord was determined. Here, we aim to draw attention to possible similar injuries., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Introduction: Interrupted aortic arch is a rare congenital malformation characterized by a complete loss of luminal continuity between the ascending and descending aorta. It is often diagnosed during the neonatal period., Case Presentation: We presented a 51-year-old male patient with interrupted aortic arch type B who was treated successfully with posterolateral thoracotomy without using cardiopulmonary bypass., Conclusion: The prognosis for interrupted aortic arch depends on the associated congenital anomalies, but the outcome is usually very poor unless there is surgical treatment. Survival into adulthood depends on the development of collateral circulation.

Introduction: The radiological diagnosis of cervical spondylotic myelopathy (CSM) has to be made as soon as possible, since surgery performed in earlier stages during the course of CSM was reported to be more successful when compared with later stages. We hypothesized that diffusion tensor imaging (DTI) may detect CSM in earlier stages, before the appearance of signal increase in T2-weighted sequences., Methods: A total of 16 patients with neurological signs and symptoms of CSM but without hyperintensity in spinal cord on T2-weighted sequences enrolled in the study. The magnetic resonance (MR) examinations were performed on a 3-T MR imaging system. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps were generated on axial plane. The ADC and FA measurements in each individual were made at the level of most severe cervical canal stenosis and at a nonstenotic level. Student's t test was used to compare FA and ADC values of the spinal cord in stenotic and nonstenotic segments. We also investigated if there was a correlation between DTI parametrics and duration of clinical symptoms by using Pearson correlation analysis., Results: All patients showed changes in DTI parametrics at stenotic segments. While FA values of the spinal cord at the stenotic level showed a statistically significant reduction, there was a statistically significant increase in the measured ADC values (p < 0.001). There was no statistical correlation between the duration of symptoms and DTI parametrics., Conclusion: Our preliminary findings indicate that DTI may show abnormalities in the spinal cord before the development of T2 hyperintensity on conventional sequences in patients with CSM.

We aimed to investigate the variances in especially the origin, course and termination of the sinoatrial node (SAN) artery in this study, using coronary CT angiography. The coronary CT angiography images of 251 patients (190 men and 61 women; age range, 20-82 years; mean age, 54.4 ± 13.6 years) were retrospectively analyzed. The SAN artery (arteries) in each case was named according to a special nomenclature with regard to their origin, course and termination. The sinoatrial node was being vascularized by a single artery in 241 (96%) cases and by two arteries in 10 (4%) cases. It was arising from RCA in 139 (55.4%) cases, from LCX in 99 (39.4%) cases, from the aorta in 2 (0.8%) cases, and from the bronchial artery in 1 (0.4%) case. The mean diameter of the SAN arteries was 2.3 mm. The mean distance between the origin of the SAN artery from RCA and the RCA ostium was 16.2 mm, from LCX and the origin of LCX was 19.3 mm. Frequency of the atrial branch was 35.9%. S-shaped SAN artery is determined in 51 (20.3%) cases. Coronary CT angiography is considerably effective in depicting the various vascularization types of SAN.

Study Design: Retrospective case series., Objective: To evaluate the safety and efficacy of prophylactic inferior vena cava filter (IVCF) to prevent pulmonary embolism (PE) in high risk patients undergoing major complex spinal surgery., Summary of Background Data: PE has been reported to be the major cause of death after spinal reconstructive surgery. Mechanical prophylaxis alone is often not sufficient whereas anticoagulation therapy carries a significant risk of bleeding complications. Prophylactic IVCF placement is advocated in high-risk patients., Methods: A total of 129 high-risk patients undergoing complex spine surgery, having prophylactic IVCF were compared to a matched cohort of age, diagnosis, and risk factors of 193 patients for whom only mechanical prophylaxis was used. Patients were observed for potential complications related to the IVCF and also for clinical signs and symptoms of PE., Results: Eight cases (4.2%) of symptomatic PE were detected in the matched cohort control group (5 cases having combined anterior + posterior surgery and 3 patients having only posterior surgery). One of them died due to massive PE (0.5%). Symptomatic PE was detected in only 2 patients (1.5%), having combined anterior + posterior surgery due to lumbar spinal stenosis in IVCF group who responded well to medical treatment (P < 0.05). No complications were associated with filter insertion., Conclusion: Prophylactic IVCF is effective and safe in prevention of pulmonary embolism in patients with risk factors for PE.

Purpose: Our aim was to investigate the [(1)H] MR spectroscopy (MRS) findings of Lafora Disease (LD), which is a disabling form of progressive myoclonic epilepsy., Methods: Twelve patients diagnosed with LD and 12 control subjects underwent MRS studies with single-voxels of 8 cc obtained in the frontal lobe, pons, and cerebellum. The metabolites and NAA/Cr, NAA/Cho, Cho/Cr, mI/Cr ratios were calculated. Subgroup analysis was also done between 5 patients with EPM2B and 6 patients with EPM2A mutations. Two investigators scored neurological symptom severity., Results: We found a statistically significant difference of NAA/Cho ratio in LD patients compared with normal controls in cerebellum (P= 0.04). In addition, both myoclonus and ataxia scores showed significant correlation with NAA/Cho ratios in the pons (P= 0.03, P= 0.04) and in the cerebellum (P= 0.04, P= 0.01), respectively., Conclusion: We conclude that the cerebellum is the mostly affected structure in LD and there are significant correlations of MRS findings with some clinical parameters. The differences in the group may be related to different genetic mutations besides disease duration and other clinical variables. MRS studies could provide insights about the severity of the involvement of LD.

Objective: The purpose of this study was to investigate the ability of magnetic resonance cholangiography (MRC) in the depiction of biliary anatomy of living liver donors by using intraoperative cholangiography (IOC) as a gold standard., Materials and Methods: Between 2004 and 2006, 86 potential adult-to-adult living donor liver transplantation donors had preoperative MRC at our institution. Of these, 24 potential donors were excluded due to various clinical factors. A total of 62 of these individuals were selected for liver donation and included in the study. MRC was performed on a 1.5-T scanner with breath-hold, rapid acquisition with relaxation enhancement (RARE) sequence with half-Fourier acquisition (HASTE; Siemens) and free-breathing, three-dimensional turbo spin-echo sequence with respiratory triggering. Thin- and thick-slab imaging techniques were employed with half-Fourier RARE MRC. IOC was performed in all 63 cases. The images of IOC and MRC were classified according to a modified Huang classification, independently. The results of the MRC were then compared with the IOC results., Results: IOC was used as the reference standard; a total of 43 (69.3%) liver donors were considered to have normal biliary anatomy, whereas 19 (30.7%) were considered to have variants of biliary anatomy. Compared with IOC, MRC correctly revealed biliary anatomy in 59 of 62 (95.1%) donors. The sensitivity, specificity, positive predictive value and negative predictive value of MRC in distinguishing normal and any type of variant biliary anatomy were 84.2%, 100%, 100%, and 93.4%, respectively., Conclusion: MRC is an effective imaging technique for the preoperative evaluation of the biliary anatomy in living liver donors. However, MRC and IOC should be considered complementary to one another in order to avoid complications.

Splenic artery aneurysms are rare but important vascular lesions that constitute approximately 60% of all visceral arterial aneurysms. Splenic artery is the third most common localization of intraabdominal aneurysm formation. Rupture is the main complication that occurs in 3%-10% of the cases. We describe a case with a proximal splenic artery aneurysm. To preserve splenic function and reduce the risk of aneurysmal rupture, we used stent-graft to embolize the aneurysm treated percutaneously. The follow up of patient was uneventful after embolization. Endovascular embolization of the splenic artery aneurysm may prevent the need for emergency surgery and also offer an effective alternative surgical treatment.

We report a case of a 35-year-old patient with clinical symptoms of portal hypertension that underwent dynamic contrast-enhanced 3D magnetic resonance angiography (MRA) of the abdomen. On breath-hold dynamic contrast-enhanced MRA in less than 4 seconds, contrast passage from the arterial to the portal system was successfully demonstrated. Patient was managed according to MRA findings., (Copyright 2002 Wiley-Liss, Inc.)