Mechanic ileus due to retroperitoneal migration of total hip prosthesis; A case report.

Intrapelvic migration of total hip prosthesis is a rare but severe complication of total hip arthroplasty that can cause severe outcomes for elderly patients. A 78-year-old female patient was referred to our hospital with the complaint of no gas-stool excretion for 3-4 days, abdominal distension, nausea, vomiting, and a preliminary diagnosis of ileus. Computed tomography showed the migration of the left total hip prosthesis to the pelvis, causing a hematoma around the prosthesis and mechanical ileus due to the compression of the hematoma. To our knowledge, this case report is the only reported mechanic ileus due to migration of total hip prosthesis. Although postop paralytic ileus is one of the complications of total hip arthroplasty, mechanical ileus has not been described before. This case report shows that mechanical ileus might be an unreported complication of total hip arthroplasty. It should be kept in mind that mechanical ileus complications may also occur after hip arthroplasty.

Evaluation of Oral Anticoagulant-Associated Intracranial Parenchymal Hematomas Using CT Findings.

PURPOSE: Intracranial hemorrhage (ICH) is one of the most serious and lethal complications of anticoagulants with a reported incidence of 5-18.5 %. Computed tomographic (CT) findings, should be carefully studied because early diagnosis and treatment of oral anticoagulant use-associated hematomas are vitally important. In the present study, CT findings of intraparenchymal hematomas associated with anticoagulant and antihypertensive use are presented. METHODS: This study included 45 patients (25 men, 20 women) under anticoagulant (21 patients) or antihypertensive (24 patients) treatment who had brain CT examinations due to complaints and findings suggesting cerebrovascular disease during July 2010-October 2013 period. CT examinations were performed to determine hematoma volumes and presence of swirl sign, hematocrit effect, mid-line shift effect, and intraventricular extension. RESULTS: The patients were 40-89 years of age. In four cases, a total of 51 intraparenchymal hematomas (42 cerebral, 7 cerebellar and 2 brain stem) were detected in multiple foci. Hematoma volumes varied from 0.09 to 284.00 ml. Swirl sign was observed in 87.5 and 63.0 % of OAC-associated ICHs and non-OAC-associated ICHs, respectively. In addition, hematocrit effect was observed in 41.6 % of OAC-associated and in 3.7 % of non-OAC-associated ICHs. Volume increases were observed in all 19 hematomas where swirl sign was detected, and follow-up CT scanning was conducted. Mortality of OAC-associated ICHs was correlated with initial volumes of hematoma, mid-line shift amount, and intraventricular extension. CONCLUSIONS: Detection of hematocrit effect by CT scanning of intracranial hematomas should be cautionary in oral anticoagulant use, while detection of swirl sign should be suggestive of active hemorrhage.

Magnetic resonance imaging findings of developmental venous anomalies.

PURPOSE: This study evaluated morphological features of developmental venous anomalies (DVAs) based on magnetic resonance imaging (MRI) findings. The study also evaluated the factors affecting the visibility of DVAs on MRI. METHODS: We reviewed contrast-enhanced MRIs of 75 patients with DVA. The images were selected from 1,165 consecutive cranial MRIs. The images were examined for the DVA location, the number of collecting veins, the collecting vein diameter, drainage veins and sinuses, any accompanying parenchymal abnormalities or lesions, and the DVA visibility on MRI. RESULTS: DVAs prevalence was determined as 6.4 %. A total of 88 DVAs were observed. Single DVAs were observed in 65 patients, two were observed in 7 patients and three were observed in 3 patients. The DVA caputs had deep localization most frequently in 54.5 % of patients. A total of 98 collecting veins were identified, with a single vein identified in 80 DVAs. A statistically significant difference (p = 0.000) was found in the diameter of the collecting veins between DVAs that were the visible and nonvisible on noncontrast MRI. CONCLUSIONS: Most frequently, a single DVA was observed in the patients. A DVA caput could be located in the deep, subcortical, juxtacortical or deep + subcortical and juxtacortical + subcortical regions. Increasing collecting vein diameter increased visibility on noncontrast MRI, and small DVAs could be overlooked, even with contrast-enhanced MRI series if the images were not examined carefully.

The removal of disinfection by-product precursors from water with ceramic membranes.

The main objective of this work was to investigate the effectiveness of ceramic ultrafiltration (UF) membranes with different pore sizes in removing natural organic matter (NOM) from model solutions and drinking water sources. A lab-scale, cross-flow ceramic membrane test unit was used in all experiments. Two different single-channel tubular ceramic membrane modules were tested with average pore sizes of 4 and 10 nm. The impacts of membrane pore size and pressure on permeate flux and the removals of UV(280 nm) absorbance, specific UV absorbance (SUVA(280 nm)), and dissolved organic carbon (DOC) were determined. Prior to experiments with model solutions and raw waters, clean water flux tests were conducted. UV(280) absorbance reductions ranged between 63 and 83% for all pressures and membranes tested in the raw water. More than 90% of UV(280) absorbance reduction was consistently achieved with both membranes in the model NOM solutions. Such high UV absorbance reductions are advantageous due to the fact that UV absorbing sites of NOM are known to be one of the major precursors to disinfection by-products (DBP) such as trihalomethanes and haloacetic acids. For both UF membranes, the ranges of DOC removals in the raw water and model NOM solutions were 55-73% and 79-91%, respectively. SUVA(280) value of the raw water decreased from 2 to about 1.5 L/mg-m by both membranes. For the model solutions, SUVA(280) values were consistently reduced to < or =1 L/mg-m levels after membrane treatment. As the SUVA(280) value of the NOM source increased, the extent of SUVA(280) reduction and DOC removal by the tested ceramic UF membranes also increased. The results overall indicated that ceramic UF membranes, especially the one with 4 nm average pore size, appear to be effective in removing organic matter and DBP precursors from drinking water sources with relatively high and sustainable permeate flux values.