Hepatic Artery Pseudoaneurysm: A Life-Threatening Complication of Liver Transplantation.

Hepatic artery pseudoaneurysm is a rare but serious complication following liver transplantation. A 50-year-old male patient with ulcerative colitis, sclerosing cholangitis, and end-stage liver disease underwent right lobe transplantation from a living donor. The patient was hospitalized because of impairment in liver function tests and massive pretibial edema three months after surgery. In color Doppler ultrasound and multidetector computed tomography, a pseudoaneurysm with peripheral large thrombus was detected at the anastomosis site extending anterior to the hepatic artery. The patient died as a result of unstable hemodynamic conditions.

Axial plane coverage and torsion measurements in primary osteoarthritis of the hip with good frontal plane coverage and spherical femoral head.

INTRODUCTION: Mechanical factors play a role in pathogenesis of primary osteoarthritis of the hip. Torsion measures were made to detect whether there is a causal relationship between increase or decrease of femoral anteversion, acetabular anteversion, and osteoarthritis. There are no studies in the literature indicating a relationship between axial plane coverage and osteoarthritis of the hip. Deficient axial plane coverage of femoral head may also play a role in pathogenesis of osteoarthritis. MATERIALS AND METHODS: Thirty patients with primary osteoarthritis of the hip and 29 control cases were included in the study. We used the method of Anda et al. (Acta Radiol Diagn 27:443-447, 1986; Comput Assist Tomogr 15:115-120, 1991) to measure axial plane anterior, posterior coverages in patients with primary osteoarthritis of the hip. The computerized tomography sections and pelvic radiographs indicated good frontal plane coverage and spherical femoral head. In addition to anterior acetabular sector angle, posterior acetabular sector angle, horizontal acetabular sector angles for axial plane coverage detection, femoral anteversion, acetabular anteversion, and McKibbin instability index were also measured. RESULTS: Posterior coverage was lower at osteoarthritic hips than the control group's hips (96.0 ± 16.7, 104.2 ± 10.6) (p < 0.05). CONCLUSION: The results may indicate that in addition to other mechanical factors, axial plane coverage, especially the posterior coverage deficiency, may play a role in the pathogenesis of hip osteoarthritis.

Is there a relation between hip torsion, coverage and osteoarthritis of the knee?

PURPOSE: Biomechanic factors play a role in the pathogenesis of knee osteoarthritis. The aim of the study was to find out whether there is a relation between femoral, acetabular anteversions, anterior, posterior acetabular coverages and primary osteoarthritis of the knee. METHODS: Thirty patients with primary osteoarthritis of the knee and 29 control subjects were enrolled into the study. Femoral anteversion, acetabular anteversion, McKibbin's instability index, anterior acetabular sector and posterior acetabular sector angles were measured using tomographic scanograms. RESULTS: There was no difference between groups for each parameter (P > 0.05). CONCLUSION: This study did not show any relationship between the axial plane changes in the hip joint and primary knee osteoarthritis.

Residual axial plane deformities after hip reconstruction for developmental dysplasia of the hip after walking age.

Children with developmental dysplasia of the hip after walking age can be treated with one-stage combined operations. In these procedures, complex deformity corrections at both frontal and axial planes are performed in the guidance of intraoperative stability tests. The reports about the results of these procedures focus on frontal plane assessments but neglect to assess axial plane corrections. We aimed to find out whether hips with unilateral developmental dysplasia of the hip, treated by one-stage combined procedures after walking age and which had good frontal plane containment at the last follow-up, had any axial plane deformities. Twenty-one patients were included in this study according to our described criteria. Mean age at the operation time was 38.04 months (range: 20-86 months), mean follow-up time was 55.54 months (range: 24-117 months) and mean age at latest follow-up was 93.46 months (range: 52-150 months). Femoral anteversions, acetabular anteversions and acetabular sector angles were measured bilaterally in the computed tomography examination. Operated hip measurements were compared with the contralateral hips. One-way variance analysis was used for statistical analysis. Femoral anteversion, acetabular anteversion and posterior acetabular sector angle values of the operated hips were found to be statistically lower than those of the contralateral hips. Our findings suggest that using the intraoperative stability test alone for planning osteotomies may lead to unsuitable femoral head coverage in axial plane although successful frontal plane containment can be obtained. We believe that strict preoperative planning that can be accomplished by a preoperative computed tomography examination should be performed in order to decide innominate osteotomy type and correction amounts.

[The results of intramedullary fixation with titanium elastic nails in children with femoral fractures]. / Cocuklardaki femur cisim kiriklarinda titanyum elastik çivilerle intramedüller tespit sonuçlari.

OBJECTIVES: We evaluated clinical and radiologic results of intramedullary fixation with titanium elastic nails (TEN) in children with femoral fractures. METHODS: The study included 35 femoral fractures of 34 patients (20 boys, 14 girls; mean age 8.3 years; range 5 to 14 years) who were treated by intramedullary fixation with TEN. The results were evaluated according to the scoring system proposed by Flynn et al. Time to union and residual angulations were assessed on anteroposterior and mediolateral radiographs. Femoral anteversion angles and limb lengths were measured in comparison with the normal side by computed tomography (CT) in 14 patients and the results were compared using the Wilcoxon test. The mean follow-up period was 28 months (range 4 to 48 months). RESULTS: According to the criteria by Flynn et al., the results were excellent in 25 fractures (71.4%), successful in nine fractures (25.7%), and poor in one fracture (2.9%). The mean time to union was 7.4 weeks (range 5 to 12 weeks). Mediolateral and anteroposterior radiographs showed an angulation of 10 degrees or less in three fractures and of 8 degrees in one fracture, respectively. Limb length discrepancy of less than 2 cm was detected in seven patients (20.6%). Femoral anteversion angles measured by CT revealed significant retroversions on the fractured sides (p<0.01). CONCLUSION: Intramedullary fixation with TEN may be the preferred method for the treatment of femoral fractures in children aged 5 to 15 years. However, residual rotation detected by CT seems to be a technical challenge to be improved.

[Evaluation of rhinorrhea by computed tomography cisternography]. / Rinorenin BT sisternografi ile degerlendirilmesi.

PURPOSE: We aimed to emphasize the indication for and importance of CT cisternography in the diagnosis of rhinorrhea patients by reviewing the literature with the support of unenhanced cranial CT findings. MATERIALS AND METHODS: Unenhanced cranial CT with axial sections and CT cisternography with coronal sections were performed in 14 patients who had spontaneous (n = 3) and posttraumatic (n = 11), intermittent or continuous CSF rhinorrhea. The slice thickness of infratentorial planes was 5 mm and supratentorial planes 10 mm. CT cisternography was performed from nasion to dorsum sella with a 3 mm slice thickness and 3 mm intervals. Bony and/or dural defects with entry of contrast into the ipsilateral paranasal sinuses were accepted as positive results. RESULTS: A CSF fistula was determined in nine of eleven posttraumatic patients. Three of them had accompanying cerebral herniation while on had a pseudomeningocele. The etiology of two spontaneous rhinorrhea patients was shown to be empty sella and meningocele pouch respectively. Eleven patients (nine posttraumatic, two spontaneous) whose CSF fistula had been shown on CT cisternography were operated on and our findings were confirmed. CSF fistula or bony defect was not observed in the CT cisternography of 3 biochemically proven rhinorrhea patients (2 posttraumatic, 1 spontaneous). These 3 patients were clinically observed and their rhinorrhea ended spontaneously. One posttraumatic patient who had had 2 operations had recurrence of rhinorrhea with an infected extradural collection six months after the operation. Another posttraumatic patient developed meningitis before CT cisternography. CONCLUSION: CT cisternography should be the preferred examination method in rhinorrhea patients, since it is cheaper than MR cisternography, is a widely used scanning technique and reduces the risks of surgical recurrences by showing the exact location of the fistula.