iatrogenic vascular injury during lumbar disc surgery, although rare, should be suspected if signs of circulatory instability are noted or if lumbar pain, leg oedema or high output cardiac failure develop months to years following such surgical procedures. However, these symptoms may arise during or immediately after surgery, requiring immediate intervention.
Purpose: To compare T2 relaxometry and magnetization transfer ratio (MTR) measurements of myocardial tissue in normal volunteers and thalassaemic patients for assessment of the myocardial iron levels.
Material and Methods: All examinations were done on a 1 T MR system using a multi‐echo spin‐echo sequence with 8 echoes for T2 measurements and a gradient echo sequence for MTR measurements. Diastolic cardiac triggering was used in both sequences. Ten patients and 10 normal subjects were included in the study. T2 and MTR measurements were correlated with serum ferritin levels.
Results: Regression analysis between T2 and MTR measurements and ferritin demonstrated a reversed linear relationship, (r=−0.932, p<0.05) and (r=−0.824, p<0.05), respectively. Mean T2 relaxation time and mean MTR of the normal subjects (57.95±4.9 ms and 43.70±3.3%) was significantly higher than that of the thalassaemic patients (38.8±6.2 ms and 26.40±6.1%) (p<0.01), respectively.
Conclusion: MTR measurements can be used to complement T2 measurements for non‐invasive myocardial iron assessment.
Bronchobiliary fistula (BBF) is a rare condition. It may present as a complication of echinococcal or amebic liver disease. Management of such a fistula can be very difficult and is often associated with a high rate of morbidity and mortality. We report the case of a 70-year-old woman who presented with a BBF after a one-stage operation for hydatid cysts of the liver and lung that were approached via thoracotomy and transdiaphragmatic incision. The cause of the BBF was an inflammatory collection in the residual liver cavity due to inadequate drainage. This collection eroded the sutured diaphragm, and because of the existing adhesions, it perforated directly into the bronchial system at the area of the previous cystectomy. Initially, endoscopic sphincterotomy was performed to achieve biliary decompression by equalizing intrabiliary and duodenal pressure, but no significant improvement was seen. Subsequently, nasobiliary drainage was instituted by means of an endoscopically inserted, nasobiliary catheter, which further reduced biliary pressure and facilitated biliary flow to the duodenum, as opposed to the fistulous tract. The fistula was successfully closed in a short time. This conservative method reduces the risks of reoperation. Therefore, it should be considered the treatment of choice in the management of bronchobiliary fistula.
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